Attention Deficit Hyperactivity Disorder

The Attention Deficit / Hyperactivity Disorder is one of the most frequent in childhood and can persist into adulthood, causing important personal and social functional alterations (Dra, 2015) report that there are multiple epidemiological and clinical studies , of molecular genetics, neuropsychology, neuroimaging and neuropharmacology that support its neurobiological origin, however, the exact etiology is not known. The diagnosis is clinical, it must be fulfilling the clinical criteria established in the DSM-5 and these may vary depending on the diagnostic classification. Mainly related to alterations in the frontostriatal and mesolimbic circuits (Ruth Cunill, 2015).

The Attention Deficit and Hyperactivity Disorder marks the tendency to oscillate over time and change its expression, both to improve and to worsen, within the factors related to the etiology of ADHD are:
Biological factors acquired during the prenatal, perinatal and postnatal periods.

  • Neurochemical factors: Generated by dysregulation of the neurotransmitters dopamine and norepinephrine.
  • Neuroanatomical factors: affecting the prefrontal and dorsolateral cortex and regions connected with it (caudate nucleus, pale nucleus, anterior cingulate gyrus and cerebellum).
  • Genetic factor and neurobiological heritability with genes for the neurotransmitters dopamine, norepinephrine and serotonin.
  • Environmental factors and dietary / nutritional factors related to the development of the central nervous system. (J. Quintero, 2014).
  • Biological factors acquired during the prenatal, perinatal and postnatal periods.

People with ADHD have difficulty maintaining attention, executive function, and working memory.

The DSM-5 (Association, 2014) states that ADHD is characterized by a pattern of behavior and cognitive functioning. (It is put from sections A to E).

  1. Persistent pattern of inattention and / or hyperactivity-impulsivity that interferes with functioning or development, characterized by 1) and / or 2)
  2. Inattention: Six (or more) of the following symptoms have been maintained for at least 6 months in a degree that does not match the level of development and that directly affects social and academic / work activities:

Note: Symptoms are not just a manifestation of oppositional behavior, defiance, hostility, or failure to understand tasks or instructions. For older adolescents and adults (17 years of age and older), a minimum of five symptoms is required.

  1. Often failure to pay proper attention to detail or careless mistakes are made in schoolwork, at work, or during other activities (e.g., details are missed or missed, work is not done with precision).
  2. Often has difficulty maintaining attention in tasks or recreational activities (eg, having difficulty maintaining attention in classes, conversations, or prolonged reading).
  3. Often does not seem to listen when spoken to directly (eg, seems to be mindful of other things, even in the absence of any apparent distraction).
  4. Often does not follow directions and does not finish schoolwork, chores, or job duties (eg, starts chores but is quickly distracted and avoids easily.
  5. Often has difficulty organizing tasks and activities (eg, difficulty managing sequential tasks; difficulty putting materials and belongings in order; careless and disorganized at work; poor time management; missing deadlines).
  6. Often avoids, dislikes, or is unenthusiastic about initiating tasks that require sustained mental effort (eg, schoolwork or housework; in older adolescents and adults, preparing reports, completing forms, reviewing long articles).
  7. Often loses things necessary for tasks or activities (eg, school supplies, pencils, books, instruments, wallet, keys, work papers, glasses, mobile).
  8. Often easily distracted by external stimuli (for older adolescents and adults, may include unrelated thoughts).
  9. Often forgets daily activities (eg, doing chores, running errands; in older teens and adults, returning calls, paying bills, keeping appointments).
  10. Hyperactivity and impulsivity: Six (or more) of the following symptoms have persisted for at least 6 months in a degree that is not consistent with the level of development and that directly affects social and academic / work activities:

Note: Symptoms are not just a manifestation of oppositional behavior, defiance, hostility, or failure to understand tasks or instructions. For older adolescents and adults (17 years of age and older), a minimum of five symptoms is required.

  1. Often fiddles with or slaps hands or feet or squirms in seat.
  2. You often get up in situations where you are expected to remain seated (eg, you get up in class, in the office, or at another workplace, or in other situations that require staying in place).
  3. Often runs around or climbs in inappropriate situations (Note: In teens or adults, may just be fidgety).
  4. Often unable to play or engage in leisure activities quietly.
  5. You are often “busy”, acting as if “driven by an engine” (eg, unable or uncomfortable being still for a long time, such as in restaurants, meetings; others may think you are restless or that you find it difficult to follow them).
  6. Often talks excessively.
  7. Often responds unexpectedly or before a question has been completed (eg, He finishes others’ sentences; does not respect turn of conversation).
  8. It is often difficult for you to wait for his turn (eg, while he is waiting in line).
  9. Frequently interrupts or intrudes with others (e.g., interferes in conversations, games, or activities; may begin to use other people’s things without waiting or receiving permission; in adolescents and adults, may intrude or anticipate what others do).
  10. Some symptoms of inattention or hyperactive impulses were present before the age of 12 years.
  11. Various symptoms of inattention or hyperactive impulse are present in two or more contexts (eg, at home, at school, or at work; with friends or relatives; in other activities).
  12. There is clear evidence that symptoms interfere with, or reduce the quality of, social, academic or work functioning.
  13. Symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (eg, mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal).
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Bibliography

Association, A. P. (2014). Guía de Consulta de los Criterios Diagnósticos del DSM-5. Washintong D.C.: APA.

Dra, B. E. (2015). Trastorno por Déficit de Atención e Hiperactividad (TDAH) en adolescentes. Revista Médica Clínica Las Condes, 52-59.

J. Quintero, C. C. (2014). Introducción y etiopatogenia del Trastorno por Déficit de Atención e Hiperactividad. Pediatría Integral, 600:608.

Ruth Cunill, J. C. (2015). Trastorno por Déficit de Atención con Hiperactividad. Medicina Clínica, 370- 375.

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