1. TRASTORNO POR DEFICIT DE
ATENCION E HIPERACTIVIDAD
(TDAH)
Dr. Luis Rodriguez
(Psiquiatra Infantil)
2. Trastorno de Déficit de Atención e Hiperactividad (TDAH)
Definición
• Condición neurobiológica que puede manifestarse durante toda la vida.
• Patrón persistente e inapropiado de inatención y/o hiperactividad-
impulsividad.
• Síntomas presentes por más de 6 meses.
• Aparece antes de los 7 años de edad.
• Genera disfunción en el desempeño escolar, laboral, social y/o familiar.
• Se presenta en dos o más sitios (p.e.: en la escuela, en la casa, en el trabajo
etc.)
Adaptado de la American Psychiatric Association, DSM-IV TR, 2000.
4. Teoría causal actual del TDAH
♦ TDAH es un trastorno del Sistema Nervioso Central.
♦ Multicausal.
♦ Existe una predisposición genética.
♦ Disminución en la disponibilidad de
Neurotransmisores (sustancias que facilitan la
comunicación neurona a neurona)
♦ Específicamente en la norepinefrina y la dopamina
5. Areas cerebrales involucradas y sus funciones
ORGANOS SENSORIALES Y SISTEMA LIMBICO
LOBULO PARIETAL Motivación y emoción
Percepción y localización CORTEZA PREFRONTAL
Función ejecutiva, analiza, planea
Manejo del tiempo, controla impulsos
Juicio y pensamiento crítico
HIPOCAMPO
Asociación,
reconocimiento
NUCLEO ACCUMBENS Y ESTRIADO
LOCUS CERULEUS, SARA Retransmisión e interrupción
Atención
Estado de alerta
6. TDAH en Niños
♦ NO ES CAUSADO POR:
• Alimentos/Dietas (azúcar)
• Mal cuidado de los niños
• Excesiva televisión o juegos de video
• Hormonas
7. TDAH: Prevalencia en Niños
♦ Prevalencia : 3%-7% de todos los niños en edad escolar.
♦ Más frecuente en varones:
• 4 varones : 1 mujer
• Las niñas presentan con mayor
frecuencia el subtipo de inatención
♦ Se presenta en todas las naciones,
grupos étnicos y clases sociales.
♦ 60% presentan síntomas cuando llegan a la adultez.
Goldman et al. JAMA. 1998;279:1100-1107. Barkley RA. Attention-deficit hyperactivity disorder. In: Mash
EJ, Barkley RA, eds. Child Psychopathology. 1996:63-112.
9. TDAH Subtipos Clinicos
Predominantemente
Inatento
20 - 30%
50 - 75%
Combinado < 15%
Predominantemente
Hiperactivo-
impulsivo
Adaptado de la American Psychiatric Association, DSM-IV TR, 2000.
10. Criterios Diagnósticos DSM-IV
A. 1 ó 2
1. Seis (o más) de síntomas de inatención por lo menos 6 meses, no relacionado al
nivel de desarrollo
a. No presta atención suficiente a los detalles, o incurre en errores por
descuido en las tareas escolares, trabajo, u otros.
b. Dificultad para mantener atención en tareas o actividades lúdicas.
c. Parece no escuchar cuando se le habla directamente.
d. No sigue las instrucciones, no finaliza tareas escolares, encargos u
obligaciones en el trabajo.
e. Dificultades para organizar tareas y actividades.
f. Evita, le disgusta o es renuente a tareas que requieran esfuerzo mental
prolongado.
g. Extravía objetos necesarios para tareas o actividades.
h. Se distrae fácilmente en actividades irrelevantes.
i. Descuido en actividades diarias.
11. Criterios Diagnósticos DSM-IV (cont.)
2. Seis (o más) síntomas de hiperactividad/ impulsividad por lo menos 6 meses,
no relacionados al nivel de desarrollo
a. A menudo mueve manos, pies o se retuerce en el asiento.
b. Se levanta de su asiento en clase o en otras situaciones en las que no
es apropiado.
c. Corre o salta excesivamente cuando es inapropiado.
d. Dificultades para jugar o realizar actividades de recreo.
e. A menudo está en marcha o actúa como si tuviera un motor.
f. A menudo habla en exceso.
g. Precipita respuestas antes de haber sido completadas
las preguntas.
h. Dificultades para guardar turno.
i. Interrumpe y se inmiscuye en actividades de otros.
12. Criterios Diagnósticos DSM-IV (cont.)
B. Los síntomas de hiperactividad-impulsividad o
desantención presentes antes de los 7 años.
C. Los síntomas se presentan en 2 o más ambientes
D. Deterioro significativo de la actividad académica,
social o laboral
E. Los síntomas no se deben a otras enfermedades
mentales como el autismo, esquizofrenia, u otras.
13. TDAH en la edad pre-escolar (3-5 años)
♦ Hiperactividad motora (“siempre en
marcha” “con el motor prendido”).
♦ Agresividad (golpea a otros).
♦ Juego muy vigoroso y hasta destructivo,
rompe objetos.
♦ “Temerario”— puede arriesgarse o
arriesgar a otros.
♦ Curiosidad insaciable.
♦ No obedece.
♦ Demandante, discute, ruidoso.
♦ Interrumpe a otros.
♦ Rabietas y pataletas.
DuPaul GJ, et al. J Am Acad Child Adolesc Psychiatry 2001;40:508-15.
14. TDAH: en la edad escolar (6 a 11 años)
♦ Bajo rendimiento académico.
♦ Se distrae fácilmente.
♦ Dificultad para organizar las tareas,
con errores, incompletas o las pierde.
♦ Llamadas de atención frecuentes.
♦ No espera turnos en los juegos
♦ Frecuentemente fuera de su asiento. ♦ Dificultad para relación con pares.
♦ Agresivo. ♦ Percibido como “inmaduro”
♦ Responde antes que le terminen de ♦ Se niega a ayudar en su casa
preguntar. ♦ Propenso a sufrir accidentes
♦ Interrumpe y se inmiscuye ♦ Baja autoestima.
Greenhill LL. J Clin Psychiatry 1998;59 Suppl 7:31-41.
16. TDAH en la Adolescencia
♦ Sensación interna de intranquilidad.
♦ Pobre autoestima.
♦ Dificultad en la relación con los pares.
♦ Conductas no modificables con recompensas ni
castigos.
♦ Se involucra en actividades de riesgo (sexuales,
abuso de sustancias etc).
♦ Desatento o negligente con su propia seguridad
(accidentes ).
♦ Problemas de aprendizaje específicos.
♦ Dificultad para organizar el trabajo escolar y
pobres resultados.
Greenhill LL. J Clin Psychiatry 1998;59 Suppl 7:31-41.
18. Consecuencias del TDAH en los padres y familiares
♦ Estrés Incrementado en padres y familiares:
• Preocupación y ansiedad
• Frustracion y rabia
♦ Baja Autoestima en padres y familiares:
• Auto culpa y depresión,
• Aislamiento social y frecuentemente autoimpuesto
♦ Mayor Pérdida de empleo
♦ Mayor desacuerdos conyugales
♦ Mayor abuso de drogas y alcohol
Murphy KR, et al. Am J Orthopsychiatry 1996;66:93-102.
19. Rendimiento Académico de niños y
adolescentes con TDAH
46.3%
50
% de niños con TDAH
40
29.3%
30
20
10.6%
10
0
Repiten al No completan la Son Expulsados
menos 1 año secundaria
Barkley RA. In Murphy KR, et al. 1998:197.
20. Riesgo lesiones en niños con TDAH no tratados
TDAH
hospital entre Octubre 1988 y Abril 1996
60
% de niños lesionados admitidos en el
Control
†
p<.001
†
†
‡
p=.05
40
‡
†
20
0
Lesiones siendo Peatón Trauma en Múltiples Admitido en UCI
o montando en Bicicleta La cabeza lesiones
DiScala C, et al. Pediatrics 1998; 102:1415-1421.
21. Violaciones de transito y accidentes en adultos con
TDAH que nunca han recibido tratamiento
* p=.004
†
p=.07
% of Sujectos que recibieron multas
90 ‡
p=.01
80 TDAH n=25
por violaciones de transito
70 Control n=23
60 * †
50
†
40
30
20 ‡
10
0
Infracciones de Exceso de Conducir Suspensión de Accidentes
tránsito Velocidad embriagado licencia Causados por
El conductor
Barkley RA, et al. Pediatrics 1996;98:1089-1095.
22. Sin Fronteras:
Encontrando las claves
Una Encuesta Internacional a 930 Padres
Patrocinado por:
23. Impacto del TDAH en el Niño
Resultados del Estudio Internacional
% En desacuerdo % De acuerdo
Preocupado de que el TDAH ponga en 10 87
riesgo el éxito académico del niño
Preocupado de que el TDAH ponga en riesgo 10 85
el éxito de la carrera universitaria
El niño ha sido excluido de actividades
sociales debido a los síntomas de TDAH 36 58
El niño causa problemas con otros en el
vecindario 52 39
24. Impacto del TDAH sobre la familia
Resultados del Estudio Internacional
% en desacuerdo % de acuerdo
Padres a menudo estresados y preocupados 7 88
acerca del TDAH de su hijo
Nuestras actividades familiares 29 60
están alteradas
Nuestro matrimonio ha sido negativamente 38 50
afectado
Encontrar niñeras ha sido difícil 41 46
Es difícil ir a lugares con mi hijo
46 43
25. Conclusiones de Investigaciones ya Existentes1
En niños
♦ 25-70% tienen problemas de aprendizaje
♦ 90% tienen un pobre desempeño escolar
♦ 50–70% tienen pobres relaciones con sus pares
♦ 25-45% desarrollan conductas antisociales
♦ Mayor estrés parental y familiar
1.
Barkley R A. Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment. 1998, Guildford Publications, New York
26. RESUMEN
1. El TDAH es una condición cuasada por el desbalance de
noradrenalina y dopamina en el SNC.
2. Tiene un patrón hereditario.
3. La prevalencia es del 3% al 7% de niños en edad escolar.
4. Existen tres subtipos: predominantemente inatento,
predominantemente hiperactivo y tipo combinado.
5. Los síntomas están presentes las 24 horas del día y en el 60%
de casos continúa hasta la adultez.
27. RESUMEN
6. Genera dificultades serias para desenvolverse en el colegio,
trabajo, entorno familiar y social.
7. Aquellas personas que no llevan tratamiento se arriesgan a no
desarrollar su potencial intelectual, a sufrir lesiones severas,
accidentes de tránsito y a otras consecuencias.
29. Tratamiento del TDAH
♦ Las estrategias de tratamiento actual del TDAH
incluyen:
• Tratamiento farmacológico
- Estimulantes
- No estimulantes
• Psicoeducación a padres y maestros
• Tratamiento Psicoterapeutico
Suele emplearse terapia farmacológica y conductual.
30. Tratamientos no probados para el TDAH
♦ Manejo de la dieta.
♦ Megavitaminas, antioxidantes y/o minerales.
♦ Entrenamiento de Integración Sensorial.
♦ Manipulación Quiropráctica del craneo.
♦ Biofeedback .
Wolraich ML, et al. Clinical Pediatrics 1997;36(9):497-504.
31. Lo que los medicamentos pueden y no pueden
hacer
Lo que los medicamentos pueden Lo que los medicamentos no pueden
hacer: hacer
Disminuir el grado de actividad Enseñar buen comportamiento.
Aquietar durante más tiempo. Enseñar a reflexionar.
Enseñar destrezas sociales.
Permitir concentrarse por más tiempo.
Enseñar material escolar pasado.
Hacer trabajos más precisos.
Enseñar a determinar en que se debe
Mejorar la atención.
concentrar.
Disminuir la impulsividad.
Enseñar a manejar los sentimientos.
Cumplir mejor con las reglas.
Hacer feliz al niño.
Pensar antes de actuar.
Ser menos agresivo. Motivar al niño.
Manejar la frustración. Resolver problemas de aprendizaje.
32. Conclusiones:
♦ EL TDAH es un trastorno neurobiológico relacionado con la química y
anatomía del cerebro.
♦ Los síntomas de desatención y/o hiperactividad-impulsividad son más
frecuentes y severos que en el resto de los niños.
♦ EL niño los padece las 24 horas del día.
♦ Los síntomas no desaparecen con la edad en la mayoría de los casos.
♦ El tratamiento debe ser multidisciplinario. Trabajar con un médico, psicólogo,
profesorado y los padres.
♦ Su objetivo consistir en mejorar el desempeño escolar, familiar, social y
laboral.
According to the APA’s DSM-IV-TR, the essential feature of Attention Deficit Hyperactivity Disorder is “a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequent and severe than typically observed in individuals at a comparable level of development.” Estimates of the prevalence of ADHD range from 3-7% of school-age children. 1 ADHD is associated with impaired academic and social functioning, and research suggests that it is associated with morbidity and poorer outcomes later in life as well. The current DSM-IV diagnostic criteria for ADHD incorporates the three principal hallmark symptoms: attention deficit or attention inconsistency, hyperactivity (may not be present in all children), and impulsive behavior. While shades of all of these three symptoms are present to varying degrees in all children, the key operative diagnostic qualifier is the careful evaluation of what constitutes inappropriate behavior leading to problems in social, scholastic, family and work environment. The test of inappropriateness rests on identifying symptoms that are maladaptive and inconsistent with developmental level. Consequently, it is not easy to precisely define ADHD, and it may never occur in its “pure” form. However, it is a distinct clinical syndrome greatly in need of early detection and treatment. Untreated, ADHD leaves millions of children and adults misunderstood and unnecessarily struggling in a hostile environment and, often, incapacitated or riddled with frustration and anger. There is also the flip side to ADHD in that many of these children have high energy, intuitiveness, creativity, and enthusiasm that can be channeled with proper therapeutic management. 1.DSM-IV-TR. Washington, DC: APA; 2000.
The prevalence of ADHD has been estimated at between 3 to 7 percent of school-age children. As you can see from the research represented on this slide, similar prevalence rates have been found in a number of international studies. This demonstrates that the misperception that ADHD is somehow just a US or a Western phenomenon is just that – a misperception. Across cultures and diagnostic criteria used, we can see that ADHD is experienced in similar ways. [Other statistics of note:] In USA: 2-5% of children (using DSM-III or III-R) or 7-8% of children (using DSM-IV) (~3-4 million), a dding Inattentive Type doubles prevalence over III-R 4-5% of adults (~12 million in US) Varies by sex, age, social class, & urban-rural No evidence for ethnic differences to date that are independent of social class and urban-rural 3:1 males:females (community children); 2:1 in adults 5:1 to 9:1 (clinical children) Reflects referral bias of males due to greater aggression and greater societal preference to refer males for treatment
So, one message that is often perpetuated in the media is that ADHD is over-diagnosed and over-treated. Well, let’s explore that concept… [Read slide]
Key Points: Overview of Areas in the Brain Implicated in ADHD Prefrontal Cortex (PFC): Part of the brain that watches, supervises, guides, directs and focuses behavior; contains executive function such as time management, judgment, impulse control, planning, organization, and critical thinking. In ADHD, the PFC seems to be most likely to be involved. 1,2,3 Orbital region: region of the prefrontal cortex located on the front undersurface of the brain; often termed the “executive control” center of the brain. Limbic system: part of the brain that is the center of memory, motivation, and emotion. Basal ganglia : Set of large structures toward the center of the brain that surround the deep limbic system; aid in integrating feelings, thoughts, and movement, as well as in helping to shift and smooth motor behavior. Locus ceruleus : Consists primarily of noradrenergic neurons (neurons activated by or that secrete norepinephrine) plays a role in attention. Transition: Now that we have discussed individual regions let’s get a little deeper and explore the two main systems implicated with ADHD, the Anterior and Posterior Attentional systems. 1 Amen DG, 87-8 9. 2 Mercugliano M. What is attention-deficit/hyperactivity disorder? Pediatr Clin North Am. 1999;46(5):831-843. Himelstein et al. The neurobiology of attention-deficit hyperactivity disorder. Frontiers in Bioscience5. April 1, 2000:461- 478. Available at: www.bioscience.org/2000/v5/d/himelste/fulltext.htm. Accessed May 20, 2001.
Support for a genetic link and a biologic basis for ADHD Research repeatedly demonstrates that ADHD runs in families. [i] Recently published data indicate that the child of an adult with ADHD has approximately a one in four chance of having ADHD. [ii] There are also indications that the type of ADHD that persists into adulthood is more highly genetic than the type that remits in childhood. [iii] A family history of alcoholism and other affective disorders seems to be associated with an increased risk for ADHD. This may imply some type of genetic commonality between these disorders. [iv] [i] Biederman J, Spencer T, 1235. [ii] Hunt RD, 163. [iii] Faraone, Biederman, Spencer, et al. AD/HD in adults: An overview. Biol Psych 2000;48:9-20. [iv] Barkley RA, 72.
Key Points: DSM-IV adopted the two-core (inattention and hyperactivity/impulsivity) diagnostic criteria forming three subtypes: predominantly inattentive, predominantly hyperactive-impulsive, and combined type. 1 The inattentive subtype may be less recognized because hyperactivity is more noticeable to observers and encompasses about a fifth to a third of ADHD patients. In contrast, the majority of ADHD patients have both attentional and motoric/impulsivity symptoms (50-75%). 2 Relative prevalence vary with age with more even distribution in adolescents and adults. Inattentive People who are inattentive have a hard time keeping their mind on any one thing and may get bored with a task after only a few minutes. They may give effortless, automatic attention to activities and things they enjoy. But focusing deliberate, conscious attention to organizing and completing a task or learning something new is difficult. Poor academic performance is the hallmark of children with the predominantly inattentive type of ADHD. Additionally, this subtype has a lower incidence of comorbidity for oppositional defiant disorder (ODD) and conduct disorder (CD). 3 Hyperactive-Impulsive People who are hyperactive always seem to be in motion. They can’t sit still. Hyperactive children squirm in their seat or roam around the room. They may wiggle their feet, touch everything. Hyperactive teens and adults may feel intensely restless. They may be fidgety or they may try to do several things at once, bouncing around from one activity to the next. People who are impulsive seem unable to curb their immediate reactions or think before they act. They may blurt out inappropriate comments or run into the street without looking. Their impulsivity may make it hard for them to wait for things they want or to take their turn in games Children in the hyperactive-impulsive subtype are more prone to behavior than academic problems. A high proportion (circa 44%) of these children also meet the ODD/CD criteria. 3 These children are also less likely to develop anxiety or depressive symptoms. Combined Children with the combined subtype of ADHD demonstrate a high percentage of both academic (circa 55%) and behavioral (circa 78%) problems. 3 This group also has the highest prevalence of comorbidities and is the most impaired subtype assessed by impairment scores. 3 References: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition. Text Revision. Washington, DC, American Psychiatric Association, 2000. 2. Barkley RA. Attention-deficit/hyperactivity disorder. In: Mash ej, Barkley RA, eds. Child Psychopathology 1996;63-112 3. Wolraich, ML, Hannah JN, Baumgaertel A, Feurer ID. Examination of DSM-IV criteria for attention-deficit/hyperactivity disorder in a county-wide sample. J Dev Behav Pediatr 1998;19:162-8.
Key Points: Preschool-age children (ages 3-5 years) with ADHD are at significant risk for behavioral, social, familial, and academic adversities relative to non-ADHD children. 1 Diagnosing very young children can be difficult because behavior that is normal for this age may look like some symptoms of ADHD (e.g. fidgeting, excessive running or climbing, difficulty awaiting turn) and differentiation of presenting symptoms does not usually occur until the school years. Inattentive symptoms may escape notice because young children are usually not required to sustain attention for long periods. Many parents of ADHD children report heightened activity or irregular sleeping habits or irregular feeding routine as early as 10 months of age. 2 References: DuPaul GJ, McGoey KE, Eckert TL, et al. Preschool children with attention- deficit/hyperactivity disorder: impairments in behavioral, social, and school functioning. J Am Acad Child Adolesc Psychiatry 2001;40:508-15. Greenhill LL. Diagnosing attention-deficit/hyperactivity disorder in children. J Clin Psychiatry 1998;59(Suppl7):31-41.
Key Points: Entering primary school involves new tasks for the developing child with ADHD. Diagnosis is easiest for the clinician when children are near the 7-year-old criterion age, and their externalizing symptoms (hyperactivity/impulsivity) are most evident. In addition to sitting in class, obeying complex rules, listening, and organizing work, school children (ages 6 –12 years) find they must cooperate with peers. At home, responsibility for chores is usually not accepted by these children, leading to the need for close supervision and the perception that these children are “immature.” Such children produce poorly organized work full of careless errors, but mostly do not complete their classwork or homework. They tend to blurt out answers before the question is asked, making them disruptive in class and resulting in frequent trips to the principal’s office. The symptoms of ADHD have a major impairing impact on peer relationships. ADHD children can be intrusive, demanding, bossy, and aggressive. They often interrupt or intrude and cannot wait their turn in games. As a result, aggression and peer rejections are predictive of later negative outcome. Patterns of conflict in academic, social, and familial domains can become established in grade school. References: 1. Greenhill LL. Diagnosing attention-deficit/hyperactivity disorder in children. J Clin Psychiatry 1998;59(Suppl7):31-41.
Key Points: Symptoms of ADHD in children entering adolescence (ages 13-18 years) most often manifest during instructional or vocational situations. At adolescence, symptoms of hyperactivity and impulsivity related to ADHD tend to diminish in intensity and are replaced with an inner restlessness. Although ADHD adolescents may show signs of procrastination and disorganization with school work, ADHD patients are still able to attain high educational and vocational goals if adequately treated. Often, adolescent ADHD symptoms reflect peer pressure, frustration, and anger. Feelings of tension, apprehension, the need for reassurance, irritability, negative self-image, and physical complaints are reported in more than 70% of ADHD patients. Not receiving adequate treatment for ADHD contributes to risky behavior for the ADHD adolescent resulting in turbulent times for the adolescents, parents, family, and possibly unpleasant conflict with the law. They are more likely than their non-ADHD peers to have or be involved in driving mishaps, accidents, and injuries. Comorbidities, especially affective disorders and substance abuse, may increase in rate with this age group.These problems place adolescents with ADHD at higher risk for school failure, poor social relationships, car accidents, delinquency and poor vocational outcomes. References: Greenhill LL. Diagnosing attention-deficit/hyperactivity disorder in children. J Clin Psychiatry 1998;59(Suppl 7):31-41.
Key Points: The social and academic impairments of children and adolescents with ADHD cause stress within the family. It is difficult to determine if the effects are a result of parenting a child with ADHD or if the parental psychopathology is contributing to the child’s psychological reaction and disorder. Of parents with ADHD children, 20% to 40% are likely to have the disorder themselves. 1 Families of children with ADHD display higher rates of alcoholism, substance abuse and depression than families of children with Downs Syndrome. 2 References: 1. Murphy KR, Barkley RA. Parents of children with attention-deficit/hyperactivity disorder: psychological and attentional impairment. Am J Orthopsychiatry 1996;66:93-102. 2. Roizen NJ. Blondis TA. Irwin M. Rubinoff A. Kieffer J. Stein MA. Psychiatric and developmental disorders in families of children with attention-deficit hyperactivity disorder. Archives of Pediatrics & Adolescent Medicine 1996; 150(2):203-8 .
Key Points: Many children with ADHD present with school difficulties including: (1) failure to complete homework, (2) poor test preparation and test-taking skills, (3) poor organizational skills, (4) poor understanding of material, (5) poor classroom participation and failure to ask teachers for needed help, (6) disruptive behavior in the classroom, and (7) truancy. Many children with ADHD also have associated learning disabilities in reading, written expression, or mathematics. As a result, they receive low grades, get into trouble with teachers, and have seemingly endless conflicts over school with their parents. As depicted on this slide, 10-35% of children with ADHD do not complete high school, 30% are retained in at least one grade, and 46% are suspended from school at least once. References: 1. Barkley RA. Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment 2 nd Edition. In: Murphy KR, Galdon M. 1998:197.
Key Points: Without treatment, ADHD presents a heightened risk for injuries, automotive crashes, traffic citations, bone fractures, and head injuries in adolescence. Possibly, inattention and/or impulsivity of ADHD do not allow the development of safety initiatives in risky situations. Injured ADHD children are more likely to suffer severe injuries than children without ADHD. Compared with the normal children, the children with ADHD were more likely to be injured as pedestrians (27.5% vs. 18.3%) or bicyclists (17.1% vs. 13.8%), and to inflict injury to themselves (1.3% vs. 0.1%). They were more likely to sustain injuries to multiple body regions (57.1% vs. 43%), to sustain head injuries (53% vs. 41%), and to be severely injured as measured by the Injury Severity Score (12.5% vs. 5.4%) and the Glasgow Coma Scale (7.5% vs. 3.4%). The ADHD mean length of stay was 6.2 days versus 5.4 in the normal group. ADHD children were admitted more frequently to the intensive care unit (37.1% vs. 24.1%). The injury led to disability in 53% of the children with ADHD vs. 48% of the normal children. Children with ADHD with any disability were twice as likely to be discharged to rehabilitation/extended care than were the normal children. 1 Background: Comparative analysis, excluding fatalities, of ADHD patients (n=240) to patients without ADHD (n=21,902) in hospital admitted injuries to children 5 through 14 years of age. Analysis was conducted by a retrospective review of charts submitted by more than 70 hospitals participating in the National Pediatric Trauma Registry between October 1988 and April 1996. 1 References: 1. DiScala C, Lesohier I, Barthel M, et al. Injuries to children with attention deficit hyperactivity disorder. Pediatrics 1998;102:1415-1421.
Key Points: Previous studies have suggested that adolescents and young adults with ADHD are more likely to be cited for speeding and to be cited more often for this and other traffic violation than are control subjects. The results of this study provide further corroboration of these driving risks. Young adult drivers with ADHD were found to be nearly twice as likely to be cited for unlawful speeding and to be cited more than three times as often than young adult subjects in the control group. 1 These results based on self-reports were validated by the official driving records of these subjects (shown in the slide). Drivers with ADHD had more than 5 times as many traffic citations on their records than did controls. 1 The totality of findings to date clearly indicates that young adults with ADHD are more likely to be apprehended for violations of traffic laws and to be cited more often for such violations. Background: A total of 25 young adults with ADHD (mean age=22.5 years ± 4) and 23 young adults without ADHD (mean age=22.0 years ± 4) 17 to 30 years old recruited from the local community were evaluated. ADHD subjects were derived from referrals at a university medical center clinic for adult ADHD and were diagnosed with ADHD based on criteria from the DSM-IV. ADHD subjects receiving treatment were required to refrain from taking their medication at least 24 hours before undergoing testing procedures because the purpose of the study was to evaluate the impact of ADHD on driving performance. The control group consisted of young adults without ADHD who were not currently receiving any psychotropic medication. 1 References: 1. Barkley RA, Murphy KR, Kwasnik D. Motor vehicle driving competencies and risks in teens and young adults with attention deficit hyperactivity disorder. Pediatrics 1996;98:1089-1095.
We know that ADHD is not a disorder that just ends in childhood. As many as 60% of people with ADHD will continue to experience the disorder as adults. But, for all people with ADHD – whether they continue to have the disorder as adults or whether they do outgrow it – the impact that the disorder has on them as children can have long-lasting consequences. This can include detrimental effects on academic and future career success, whether they will be able to develop the necessary social skills to carry them through life, and the ability to consider the consequences of one’s actions to stay out of trouble in the neighborhood or with the law. For instance… [Read slide]
As I’ve already stated, ADHD reaches beyond the child with the disorder to impact the entire family. In this survey, at least half of the parents reported that their marriage was negatively impacted by the disorder and that their family activities were disrupted. A high 88% of parents reported often being stressed or worried about their child’s ADHD. Substantial numbers also reported difficulty finding babysitters or going places with their child. One other point to consider… These findings not only demonstrate the stress for parents and a child with ADHD. We should also consider the impact on the brothers or sisters living in the household who do not have the disorder but are finding their lives disrupted.
As I mentioned earlier, there is extensive research into the impact of ADHD. What parents are telling us in this survey is backed up by additional findings. What we see here is a clear picture of the damage that ADHD can cause among children. [Read slide]
References: 1. Wolraich ML, et al. The practical aspects of diagnosing and managing children with attention deficit hyperactivity disorder. Clin Pediatrics 1997 ; 36(9):497-504.
