KULIAH BLOK XVI

FK UMP 2015
ADHD is a behavioral syndrome that appears
early in the child life, typically persist
throughout childhood and adolescence.

It is associated with a triad of symptoms:

- hyperactivity,
- inattentiveness, and
- impulsivity
 Affect 4 10 % of elementary school-aged
children
Up to 20 % in lower socioeconomic status
Male to female ratio = 6 : 1
There are multiple causes :
Genetic factors
Differences in the brain (neuroanatomy &
neurotransmiters)
Environmental factors :
Parental psychopathology,
Low socioeconomic status,
Poor monitoring of behavior,
A punitive approach to discipline
ADHD afflicted children display various
behavior indicative of problem with
Attention
Hyperactivity
Impulsivity
A. Inattention or hyperactivity-impulsivity
B. Some symptoms that caused impairments
were present < age 7 yr
C. Impairment are present in > 2 setting
D. Clinically significant impairment in social,
academic or occupational
E. Doesnt occur during the course of a
pervasive disorder, schizophrenia or
other psychotic disorder
 At least six symptoms of inattention,
persisted at least 6 months,
That is maladaptive and inconsistent with
developmental level
 Often fails to give close attention to details,
makes careless mistaken in schoolwork,
work and other activity
Often has difficulty sustaining attention in
tasks or play activity
Often doesnt seem to listen
Often doesnt follow through on instruction
and fail to finish schoolwork, chores, or
duties
 Often has difficulties organizing tasks and
activity
Often avoids, expresses reluctance about,
or has diffuculties engaging in tasks
Often loses things necessary for tasks or
activity
Often easily distructed by extraneous
stimuli
Often forgetful in daily activities
 At least 5 simptoms of hiperactivity-
impulsivity, persisted for at least 6 months
That is maladaptive ans inconsistent with
developmental level
 Often fidgets with hands or feet or
squirms in seat
Leaves seat in classroom or in other
situations
Often runs about or climbs excessively
Often has difficulty playing or engaging
in leisure activity quietly
Is always on the go or act as if driven
by a motor
Often talks excessively
 Often blurts out answers to questions before
the questions have been completed
Often has difficulty waiting in lines or
awaiting turn in games or group situations
Often interrupts or intrudes on others
 ADHD predominantly inattentive type
ADHD predominnantly hyperactive
impulsive type
ADHD combined type
 Pervasive developmental disorder (autisme,
autistic-like disorder)
Major affective disorder (depression)
Reaction to stress
Hyperthyroidisme
Iron deficiency anemia
Lead toxicity
Hearing loss
1. Medication : CNS stimulant

Methylphenidate 0,3 mg/kg/dose, twice

daily, increase by 0,15 mg/kg/dose
Dextroamphetamine 0,15 mg/kg/dose, twice
daily, increase by 0,15 mg/kg/dose
Pemoline 37,5 mg in AM
 Psychological therapy
Teaching effective behavioral management
skills to parents & teachers
Child and parent counseling
Group social skills training
Family therapy, dinamic
Family therapy, communication skills
Child psychotherapy
 50% of these children function well in
adulthood
The remaining continue to exhibit
symptoms of inattention and impulsivity
Delinquent behavior during adolescence
and later antisocial personality (50-80%)
Alcohol abuse & drug use are quite
prevalent
Poor outcomes are most common in children
who
exhibit defiance and agression toward adult,
have poor relationships,
Below average cognitive function