Etiology Over the past few years there have been more theories developed explaining the possible cause of ADHD (Attention deficit/ hyperactivity disorder). There is some suggestion that a genetic cause could contribute, recent reports indicate possible mutations in dopamine transporter genes (Ferguson, 2010). There are significant brain differences in children and adults with ADHD. Differences have been seen in anatomy, electrical activity, psychological functions, brain metabolism, and blood flow. Although there is no solid evidence of congenital factors, ADHD is more prevalent in children born to women who were substance abusers during pregnancy and there are signs that it may run in families.
The pathophysiology of ADHD is unclear although there are several theories. Research on children with ADHD shows there is a general reduction in brain volume, with a greater reduction on the left sided prefrontal cortex (Farone, 2008). This finding suggests that the core of ADHD symptoms may reflect frontal lobe dysfunction. But there have been implications to other parts of the brain, like the cerebellum. As mentioned earlier, there are variances in the dopamine transporters of those afflicted.
Signs and Symptoms Inattention, hyperactivity, disruptive behavior, and impulsivity are commonly seen in ADHD.
Predominantly inattentive type symptoms as listed by the U.S. National Institute of Mental Health may include (Ferguson, 2010):
Being easily distracted, miss details, forget things, and frequently switch from one activity to another
Have difficulty maintaining focus on one task
Become bored with a task after only a few minutes, unless doing something enjoyable
Have difficulty focusing attention on organizing and completing a task or learning something new or trouble completing or turning in homework assignments, often losing things (e.g., pencils, toys, assignments) needed to complete tasks or activities
Doesn’t seem to listen when spoken to
Have difficulty processing information as quickly and accurately as others
Struggle to follow instructions.
Predominantly hyperactive-impulsive type symptoms may include (Rogge, 2012):
Fidget and squirm in their seats
Dash around, touching or playing with anything and everything in sight
Have trouble sitting still during dinner, school, and story time
Be constantly in motion
Have difficulty doing quiet tasks or activities
Also these manifestations primarily of impulsivity:
Be very impatient
Blurt out inappropriate comments, show their emotions without restraint, and act without regard for consequences
Have difficulty waiting for things they want or waiting their turns in games
Expected Course There is no cure for, nor is there a specific course for ADHD, although it is primarily diagnosed in children. An increase in adult age diagnosis has come about, but it is believed that they may have already exhibited symptoms when they were younger but were not diagnosed until adulthood. Children with ADHD will continue to have ADHD through adult age, although there are cases where pharmacotherapy may be stopped as the patient matures. If it is not treated properly there is a risk of other problems developing, such as: alcohol and drug dependence, trouble with the law, and problems keeping a job (Rogge, 2012).
A combination of behavioral therapy and medication is considered the best approach (Rogge, 2012). The medications used are commonly stimulants which have a calming effect on those with ADHD. Behavioral therapy is often done one-on-one with the patient and includes some family therapy also. Behavior therapy is often started before medications so that the therapist has a chance to observe the patient to decide if it is truly and ADHD diagnosis.
Patient Case Hannah G. is a 6-year-old girl who presents to the pediatric clinic with her mother, Ms. G. She