Attention deficit disorders in children and adolescents

The neurophysiology of attention-deficit/hyperactivity disorder

Recent reviews of the neurobiology of Attention-Deficit/Hyperactivity Disorder (AD/HD) have concluded that there is no single pathophysiological profile underlying this disorder. Certainly, dysfunctions in the frontal/subcortical pathways that control attention and motor behavior are implicated. However, no diagnostic criteria or behavioral/neuroimaging techniques allow a clear discrimination among subtypes within this disorder, especially when problems with learning are also considered. Two major Quantitative EEG (QEEG) subtypes have been found to characterize AD/HD. Here we review the major findings in the neurophysiology of AD/HD, focusing on QEEG, and briefly present our previous findings using a source localization technique called Variable Resolution Electromagnetic Tomography (VARETA). These two techniques represent a possible objective method to identify specific patterns corresponding to EEG-defined subtypes of AD/HD. We then propose a model representing the distribution of the neural generators in these two major AD/HD subtypes, localized within basal ganglia and right anterior cortical regions, and hippocampal, para-hippocampal and temporal cortical regions, respectively. A comprehensive review of neurochemical, genetic, neuroimaging, pharmacological and neuropsychological evidence in support of this model is then presented. These results indicate the value of the neurophysiological model of AD/HD and support the involvement of different neuroanatomical systems, particularly the dopaminergic pathways.

Diagnosis and management of children with attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder (ADHD) is one of the most prevalent childhood psychiatric disorder which is characterized by three core symptoms of inattention, hyperactivity and impulsivity. It is estimated that 5% to 10% of school aged children suffer from this disorder. This disorder is more common in boys than girls. Comorbidity is a major problem and is present in as many as two thirds of children with ADHD. A multiple modality approach to treatment which combines pharmacotherapy, psycho education, behaviour therapy, environmental changes and social skills training is recommended. The outcome of ADHD is variable and unless properly treated in early years may predispose the child to serious psychopathology in adulthood.

[Use of amitriptyline in attention deficit hyperactivity disorder]

We studied the action of amitriptyline (AMI) in the attention deficit hyperactivity disorder (ADHD). Twenty-five children who came to consultation for ADHD were analyzed, in two groups: the group which used AMI (n = 18) at 1.6 mg/kg/day and the group which used placebo (n = 7). Both groups were submitted to two assessments in a 30 days interval, which consisted of the evolutive neurological evolution examination (ENE) and the WISC scale subtests on numbers, drawings to be completed and the code. The results showed that the AMI produced an improvement in performance in the motor persistence tests.

A study of the cognitive and psychological profile in 16 children with congenital or juvenile myotonic dystrophy

We report data on intelligence and on possibly associated psychopathology in 16 children and adolescents, between 7 and 18 years of age, with congenital or juvenile myotonic dystrophy. We found that all the subjects have an intelligence level below the population mean, four of them in the mentally retarded range. An unexpected number of subjects are in the clinical range on the Child Behavior Checklist. In nine of the 16 subjects, a child psychiatric diagnosis was found using a standardized psychiatric interview. The most frequent child psychiatric diagnosis was Attention Deficit Hyperactivity Disorder.

[Normalization of a computerized visual attention test (TAVIS)]

The authors present the normative data of a computerized test (TAVIS) that address visual attention in children and adolescents being the first neuropsychological instrument as such devised and developed in Brazil. Selective, alternate and sustained attention aspects are evaluated through three different tasks. Omission and action errors as well as time reaction are evaluated. The advantages and limitations of the test are commented.

Prevalence and implications of attention-deficit hyperactivity disorder among adolescents in treatment for substance abuse

OBJECTIVE

Attention-deficit hyperactivity disorder (ADHD) is overrepresented among adults and adolescents in treatment for substance abuse. This study was designed to assess the prevalence of ADHD and to elucidate differences among adolescent substance abusers relative to ADHD symptomatology.

METHOD

The Wender Utah Rating Scale and the Self-Evaluation (Teenager's) Self-Report were used to evaluate childhood history of ADHD and current symptoms, respectively, and the Child Attention Problems Scale was completed by treatment program clinicians. A quantitative substance use history and a subjective substance use interview were also administered.

RESULTS

A total of 50% of 14 females and 16 males, ranging in age from 14 to 19, met study criteria for ADHD. ADHD subjects began drug use at an earlier age, had more severe substance abuse, and had a more negative self-image prior to drug use and improved self-image with drug use. They experienced more negative affective responses related to substance use and more drug craving and attentional difficulties in treatment than control subjects.

CONCLUSIONS

The results support a substantial comorbidity of ADHD among adolescent substance abusers, with indications of drug use for self-medication. Counseling for ADHD and medication may be indicated to improve treatment outcome and future functioning.

Attention deficit disorder during adolescence: a review

Attention deficit disorder (ADD) in adolescents has received scant attention when compared with that given to children. With or without hyperactivity, ADD does not disappear at puberty and is an important factor in scholastic and social failure in adolescents. As a condition associated with decreased metabolism in the premotor and prefrontal superior cerebral cortex, ADD in adolescents responds well to treatment with stimulants, tricyclic antidepressants and monoamine oxidase inhibitors. Nonpharmacologic modalities such as behavior modification, individual and family therapy, and cognitive therapy are useful adjuncts to psychopharmacologic management. Without effective treatment, ADD often results in increased risk of trauma, substance abuse and conduct and affective disorders during adolescence, and marital disharmony, family dysfunction, divorce, and incarceration in adulthood. Properly treated with medication and counseling, adolescents with ADD succeed as well as their peers.

Attention deficit disorder in college students: facts, fallacies, and treatment

Attention deficit disorder (ADD), with or without hyperactivity, is a common but highly misunderstood and frequently underdiagnosed condition in college students. It affects students' academic and social success and emotional development. ADD is an invisible impairment of cortical regulation of activity and impulse control that is often hereditary, is as common in women as in men, and does not subside or disappear at puberty. ADD increases the risk of drug abuse, delinquency, incarceration, job failure, marital discord, and divorce. In college students, ADD is amenable to treatment in a multimodal program combining medication; individual, family, and group psychotherapy; career counseling; and cognitive control, together with electronic prostheses and special accommodations in the college classroom.

Abnormal regional CBF response in left hemisphere of dysphasic children during a language task

This study used xenon 133 inhalation and single-photon computed tomography to measure regional cerebral blood flow during a quiet resting condition, a simple auditory task, and an auditory phonemic discrimination task in 3 age-matched groups of children suffering from developmental language disabilities: expressive dysphasia, expressive-receptive dysphasia, and attention-deficit hyperactivity disorder. An absence of left hemisphere activation was observed in the expressive-receptive group during the phonemic discrimination task as compared to both expressive and attention-deficit hyperactivity disorder children, together with an absence of left inferior parietal region activation in dysphasics as compared to hyperactive children. These results favor the hypothesis of an abnormal lateralization for language in dysphasic children and point toward possible different pathologic localizations in the different clinical subtypes of dysphasia.

Attention deficits: current concepts, controversies, management, and approaches to classroom instruction

This article reviews the current criteria for diagnosis of Attention-Deficit Hyperactivity Disorder and Undifferentiated Attention-Deficit Disorder, according to the American Psychiatric Association, and describes other typical presenting features of children with attentional disorders. The current theories of the biological basis of attentional disorders are reviewed. Treatments of attentional disorders are discussed, including medical treatments with stimulants and tricyclic antidepressants, and non-medical treatments, such as behavior modification, psychotherapy, diets, and specific educational modifications that are felt to be helpful. Finally, our current thinking about the long-term outlook for children with attentional disorders is summarized.

Psychopharmacology in children with developmental disabilities

A variety of motor and behavioral symptoms may cause functional impairment in children with developmental disabilities. Some of these symptoms, including increased tone, involuntary movements, and disruptive behaviors, may be helped by multimodal treatments that include pharmacotherapy. Treatment with psychopharmacologic agents can also cause unwanted CNS side effects that can be as detrimental as the target symptom, however. Identification and measurement of target symptoms at baseline and maintenance drug conditions, in conjunction with careful medical monitoring, provide the pediatrician and family with the information needed to make decisions about drug treatment.

A practical approach to children failing in school

The most likely causes of failure in school in otherwise capable children who come from homes in which they are loved and cared for are learning disabilities, affective illness, primary disorder of vigilance and, on occasion, narcolepsy. The various learning disabilities are often accompanied by problems of attention, concentration, organization, mood and feelings, and social interaction. These latter problems are reflections of biochemical disorders that respond effectively to judicious pharmacologic intervention. When this type of medical management is combined with constructive counseling and suitable curriculum adjustments, the child can attain his or her maximum education potential and become a productive and contributing adult member of society.