Attention-Deficit/Hyperactivity Disorder (ADHD) in Pediatrics

00:01 In this lecture, we will discuss attention deficit hyperactivity disorder.

00:06 ADHD or attention deficit hyperactivity disorder is sometimes also called ADD or attention deficit disorder when there is less hyperactivity.

00:17 So there are really a few different types of ADHD and I want to discuss them with you.

00:24 It’s basically, in general, an impairment in functioning in at least two settings.

00:29 Usually, home and school, due to impulsivity, inattention, or hyperactivity.

00:36 So let’s discuss the three major types.

00:39 We have the combined type which is the most common.

00:42 Patients with this problem have difficulty with attention and focus and have some hyperactive or impulsive behavior.

00:50 In the inattentive type, which is the second most common, they may have difficulty with attention, but there is no significant hyperactive or impulsive behaviors.

00:59 And then in the hyperactive-impulsive type which is less common, there’s less problems with attention and it’s more common maybe in preschoolers where they mostly have the hyperactive component.

01:12 So there seems to be some genetic predisposition to this problem.

01:17 Boys are much more likely than girls to get the problem.

01:20 A child of a parent with ADHD has a 25% chance of developing ADHD themselves.

01:28 Also, there is a 55-90% monozygotic twin concordance.

01:33 In other words, there seems to be some strong genetics at work here.

01:37 There are also syndromes that are genetic that are predisposed to developing ADHD.

01:44 Children with Klinefelter’s, children with Turner’s, children with fragile X, children with neurofibromatosis type 1 or Williams syndrome or even DiGeorge syndrome are at increased risk for attention deficit hyperactivity disorder.

01:59 So there are also, however, environmental factors at work.

02:05 Patients with lower socioeconomic status are more prone to the problem, as our patients with parents who have mental disorders.

02:13 Children in foster care are more likely to have ADHD.

02:17 Children who were of low birth weight or prematurity are more likely to have ADHD.

02:21 And children with acquired traumatic brain injury may develop ADHD.

02:27 So ADHD may present differently depending on the age at which that child is being brought to attention.

02:34 In the preschool era, hyperactivity is usually a larger component.

02:39 These patients may be impulsive.

02:41 They are not flexible with their environment.

02:44 In other words, if something has significantly changed, they don’t tolerate it very well.

02:48 And they may be aggressive with their peers.

02:51 In the elementary school era, these children now start to struggle with listening in class.

02:56 They have poor organizational skills.

02:59 They struggle with social interaction.

03:01 And they may have difficulty functioning independently.

03:04 And as adolescents, they have a problem with academic demands.

03:11 As high school starts and these children have increased responsibility academically, they can really start to struggle.

03:18 And they can start to struggle with attention, learning, and even executive functioning.