9.6: ADHD and PDD

Attention Deficit/Hyperactivity Disorder (AD/HD)

The exact causes of AD/HD are unknown; however, research has demonstrated that factors that many people associate with the development of AD/HD do not cause the disorder including, minor head injuries, damage to the brain from complications during birth, food allergies, excess sugar intake, too much television, poor schools, or poor parenting. Research has found a number of significant risk factors affecting neurodevelopment and behavior expression. Events such as maternal alcohol and tobacco use that affect the development of the fetal brain can increase the risk for AD/HD. Injuries to the brain from environmental toxins such as lack of iron have also been implicated.

Symptoms of AD/HD

People with AD/HD show a persistent pattern of inattention and/or hyperactivity–impulsivity that interferes with functioning or development:

1. Inattention: Six or more symptoms of inattention for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:

• Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
• Often has trouble holding attention on tasks or play activities.
• Often does not seem to listen when spoken to directly.
• Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
• Often has trouble organizing tasks and activities.
• Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
• Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
• Is often easily distracted
• Is often forgetful in daily activities.

  

  Figure \(\PageIndex{1}\): This child is exhibiting inattention while his classmates are focused in the class activities.[1]

2. Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level:

• Often fidgets with or taps hands or feet, or squirms in seat.
• Often leaves seat in situations when remaining seated is expected.
• Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
• Often unable to play or take part in leisure activities quietly.
• Is often “on the go” acting as if “driven by a motor”.
• Often talks excessively.
• Often blurts out an answer before a question has been completed.
• Often has trouble waiting his/her turn.
• Often interrupts or intrudes on others (e.g., butts into conversations or games)

Figure \(\PageIndex{2}\): This child is exhibiting hyperactivity and impulsivity.[2]

In addition, the following conditions must be met:

• Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
• Several symptoms are present in two or more settings, (such as at home, school or work; with friends or relatives; in other activities).
• There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.
• The symptoms are not better explained by another mental disorder (such as a mood disorder, anxiety disorder, dissociative disorder, or a personality disorder). The symptoms do not happen only during the course of schizophrenia or another psychotic disorder.

Based on the types of symptoms, three kinds (presentations) of AD/HD can occur:

• Combined Presentation: if enough symptoms of both criteria inattention and hyperactivity-impulsivity were present for the past 6 months
• Predominantly Inattentive Presentation: if enough symptoms of inattention, but not hyperactivity-impulsivity, were present for the past six months
• Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of hyperactivity-impulsivity, but not inattention, were present for the past six months.

Because symptoms can change over time, the presentation may change over time as well.[3]

The diagnosis of AD/HD can be made reliably using well-tested diagnostic interview methods. However, as of yet, there is no independent valid test for ADHD.

Among children, AD/HD frequently occurs along with other learning, behavior, or mood problems such as learning disabilities, oppositional defiant disorder, anxiety disorders, and depression.

Treatment

A variety of medications and behavioral interventions are used to treat AD/HD. The most widely used medications are methylphenidate (Ritalin), D-amphetamine, and other amphetamines. These drugs are stimulants that affect the level of the neurotransmitter dopamine at the synapse. Nine out of 10 children improve while taking one of these drugs.

Figure \(\PageIndex{3}\): Brain scan showing affected area of brain in ADHD.[4]​​​​​​​

In addition to the well-established treatments described above, some parents and therapists have tried a variety of nutritional interventions to treat AD/HD. A few studies have found that some children benefit from such treatments. Nevertheless, no well-established nutritional interventions have consistently been shown to be effective for treating AD/HD.[5]

Pervasive Developmental Disorder (PDD) or PPD (NOS) Not Otherwise Specified PDD –NOS

Pervasive developmental disorder (PDD) is a term used to refer to difficulties in socialization and delays in developing communicative skills. This is usually recognized before 3 years of age. A child with PDD may interact in unusual ways with toys, people, or situations, and may engage in repetitive movement. PDD is diagnosed and treatment is similar to ADHA and ASD. In 2013 the DSM- 5 discontinued using this as a diagnosis, however it is still used informally.[6]

Attributions:

Child Growth and Development by Jennifer Paris, Antoinette Ricardo, and Dawn Rymond, 2019, is licensed under CC BY 4.0

[1] Image by Ben Paarmann is licensed under CC BY 2.0

[2] Image by Marc Lewis is licensed under CC BY-SA 2.0

[3] Symptoms and Diagnosis of ADHD by the CDC is in the public domain

[4]Image, by scientific animations, licensed CC BY-SA 4.0, via Wikimedia Commons

[5] Disease Prevention and Healthy Lifestyles by Judy Baker, Ph.D. is licensed under CC BY-SA

[6] Lifespan Development: A Psychological Perspective by Martha Lally and Suzanne Valentine-French is licensed under CC BY-NC-SA 3.0