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M. Faisal Idrus

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• Apparent in some children in the preschool andearly school years

•

Estimated that between 3 and 5 percent ofchildren have ADHD,• first described by Dr. Heinrich Hoffman in 1845

• 1902 that Sir George F. Still described a group of

impulsive children with significant behavioralproblems, recognized as having ADHD

• ADHD often continues into adulthood

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There is considerable evidence to suggest that ADHD is not arecent phenomenon 493 BC, the great physician-scientist Hippocrates described a condition

that seems to be compatible with what we now know as ADHD.Hippocrates attributed this condition to an "overbalance of fire overwater”.

1845. ADHD was alluded to by Dr. Heinrich Hoffmann, a Germanphysician in Der Struwwelpeter  was a description of a little boy who couldbe interpreted as having attention deficit hyperactivity disorder.

1902 – The English pediatrician George Still, described a condition whichsome have claimed is analogous to ADHD. Analysis of Still's descriptionsby Palmer and Finger indicated that the qualities Still described are not"considered primary symptoms of ADHD".[62] 

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The 1918–1919 influenza pandemic left many survivors with encephalitis,affecting their neurological functions. Some of these exhibitedimmediate behavioral problems which correspond to ADD. This causedmany to believe that the condition was the result of injury rather than

genetics. 1937 – Dr. Bradley in Providence RI reported that a group of children with

behavioral problems improved after being treated with stimulantmedication.

1957 – The stimulant methylphenidate (Ritalin) became available. It

remains one of the most widely prescribed medications for ADHD in itsvarious forms (Ritalin, Focalin, Concerta, Metadate, and Methylin).

1960 – Stella Chess described "Hyperactive Child Syndrome", introducingthe concept of hyperactivity not  being caused by brain damage.

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By 1966, following observations that the condition existed without anyobjectively observed pathological disorder or injury, researchers changedthe terminology from Minimal Brain Damage to Minimal BrainDysfunction.[65] 

1973 – Dr Ben F. Feingold, Chief of Allergy at Kaiser Permanente MedicalCenter in San Francisco, claimed that hyperactivity was increasing inproportion to the level of food additives.

1975 – Pemoline (Cylert) is approved by the FDA for use in the treatmentof ADHD. While an effective agent for managing the symptoms, the

development of liver failure in at least 14 cases over the next 27 yearswould result in the manufacturer withdrawing this medication from themarket.

1980 – The name Attention Deficit Disorder  (ADD) was first introduced inDSM-III, the 1980 edition.

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1987 – The DSM-IIIR was released changing the diagnosis to "UndifferentiatedAttention Deficit Disorder."

1994 – DSM-IV described three groupings within ADHD, which can be simplified as:mainly inattentive; mainly hyperactive-impulsive; and both in combination.

1996 – ADHD accounted for at least 40% of child psychiatry references.

1999–

 New delivery systems for medications are invented that eliminate the need formultiple doses across the day or taking medication at school. These new systemsinclude pellets of medication coated with various time-release substances to permitmedications to dissolve hourly across an 8–12 hour period (Medadate CD, Adderall XR,Focalin XR) and an osmotic pump that extrudes a liquid methylphenidate sludgeacross an 8–12 hour period after ingestion (Concerta).

1999 – The largest study of treatment for ADHD in history is published in the American

Journal of Psychiatry. Known as the Multimodal Treatment Study of ADHD (MTAStudy), it involved more than 570 ADHD children at 6 sites in the United States andCanada randomly assigned to 4 treatment groups. Results generally showed thatmedication alone was more effective than psychosocial treatments alone, but thattheir combination was beneficial for some subsets of ADHD children beyond theimprovement achieved only by medication. More than 40 studies have subsequentlybeen published from this massive dataset.

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1999 – The largest study of treatment for ADHD in history is published inthe American Journal of Psychiatry. Known as the Multimodal TreatmentStudy of ADHD (MTA Study), it involved more than 570 ADHD children at6 sites in the United States and Canada randomly assigned to 4treatment groups. Results generally showed that medication alone wasmore effective than psychosocial treatments alone.

2001 – The International Consensus Statement on ADHD is published andsigned by more than 80 of the world's leading experts on ADHD tocounteract periodic media misrepresentation that ADHD is a realdisorder and that medications are justified as a treatment for thedisorder

2003 – Atomoxetine, the first new medication for ADHD in 25 years,

receives FDA approval for use in children, teens, and adults with ADHD. In 2005, another 100 European experts on ADHD added their signatures

to this historic document certifying the validity of ADHD as a validmental disorder.

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• Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)states that ADHD is a developmental disorder that presents duringchildhood, with at least some symptoms causing impairmentbefore the age of seven. It is characterized by developmentallyinappropriate levels of inattention and/or hyperactive-impulsivebehavior, with significant impairment occurring in at least twosettings

• International Statistical Classification of Diseases and RelatedHealth Problems (ICD-10) the symptoms of ADHD are given thename "Hyperkinetic disorders". When a conduct disorder (asdefined by ICD-10, F91) is present, the condition is referred to as"Hyperkinetic conduct disorder". Otherwise the disorder isclassified as "Disturbance of Activity and Attention", "OtherHyperkinetic Disorders" or "Hyperkinetic Disorders, Unspecified".

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• Attention-deficit syndrome (ADS): Equivalentto ADHD, but used to avoid the connotations of"disorder".[ 

•

Minimal cerebral dysfunction (MCD):Equivalent to ADHD, but largely obsolete in theUnited States, though still commonly usedinternationally.

• Deficits in Attention, Motor control andPerception (DAMP): A name for ADHD incombination with dyspraxia that is recognizedonly in Denmark and Sweden.

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• ADHD has been found to exist in every countryand culture studied to date.

• The prevalence among children is estimated to

be in the range of 5% to 8% in children, and 4%to 8% in adults. 10% of males, and (only) 4% offemales have been diagnosed.

• This apparent sex difference may reflect either a

difference in susceptibility.• Females with ADHD are less likely to be

diagnosed than males.

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The exact cause of ADHD remains unknown, butthere is no shortage of speculation concerning

its etiology, most of which centers around thebrain.

• Hereditary dopamine deficiency• Diet

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• Research suggests that ADHD arises from acombination of various genes, many of which havesomething to do with dopamine transporters. 

•

Suspect genes include the 10-repeat allele of theDAT1 gene, the 7-repeat allele of the DRD4 gene, andthe dopamine beta hydroxylase gene (DBH TaqI). 

• Additionally, SPECT scans found people with ADHD tohave reduced blood circulation, and a significantlyhigher concentration of dopamine transporters in thestriatum which is in charge of planning ahead.

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• It has long been suggested that ADHD could be the result of a nutritionalproblem.

• Recent studies have begun to find metabolic differences in thesechildren, indicating that an inability to handle certain elements of one'sdiet might contribute to the development of ADHD, or at least ADHD-

like symptoms. For example,• In 1990 the English chemist, Neil Ward, showed that children with ADHD

lose zinc when exposed to a food dye.• Some studies suggest that a lack of fatty acids, specifically omega-3 fatty

acids can trigger the development of ADHD.• Support for this theory comes from findings that children who are

breastfed for six or more months seem to be less likely to have ADHDthan their bottlefed counterparts and until very recently, infant formuladid not contain any omega-3 fatty acids at all. 

• Time and further investigation will perhaps tell whether this correlation isreliable or merely a coincidence.

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• Biohazards including alcohol, tobacco smoke, andlead poisoning.

• Allergies (including those to artificial additives)• complications during pregnancy and birth--including

premature birth.• women who smoke while pregnant are more likely to

have children with ADHD. Since nicotine is known tocause hypoxia (lack of oxygen) in utero,

• Head injuries can cause a damage done to thepatient's frontal lobes. Because symptoms wereattributable to brain damage, the earliest designationfor ADHD was "Minimal Brain Damage".

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• Failing to pay close attention to details or making carelessmistakes when doing schoolwork or other activities

• Trouble keeping attention focused during play or tasks• Appearing not to listen when spoken to• Failing to follow instructions or finish tasks• Avoiding tasks that require a high amount of mental effort and

organization, such as school projects• Frequently losing items required to facilitate tasks or activities,

such as school supplies• Excessive distractibility• Forgetfulness• Procrastination, inability to begin an activity• Difficulties with household activities (cleaning, paying bills, etc.)

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• Fidgeting with hands or feet or squirming in seat• Leaving seat often, even when inappropriate• Running or climbing at inappropriate times• Difficulty in quiet play• Frequently feeling restless• Excessive speech• Answering a question before the speaker has finished• Failing to await one's turn• Interrupting the activities of others at inappropriate

times• Impulsive spending, leading to financial difficulties

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• A positive diagnosis is made if the patient hasexperienced six of the above symptoms for atleast three months.

• Symptoms must appear consistently in variedenvironments (e.g., not only at home or onlyat school) and interfere with function.

•

Children who grow up with ADHD oftencontinue to have symptoms as they grow intoadulthood

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Learning Disabilities. Tourette Syndrome.

Oppositional Defiant Disorder Conduct Disorder. Anxiety and Depression Bipolar Disorder

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• Mainstream Treatment• Stimulant•

Nonstimulant• Alternative treatment

• Nutrition

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• Stimulant, stimulating the areas of the brain responsible

for focus, attention, and impulse control. paradoxical effect.

•

Methylphenidate (Ritalin and Concerta),• Amphetamines (Adderall) and• dextroamphetamines (Dexedrine). ,

• Cylert.

•

Nonstimulant• Bupropion (Wellbutrin)• Atomoxetine (Strattera).

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• NutritionFeingold diet, Removing salicylates, artificial colors and

flavors, and certain synthetic preservatives fromchildren's diets.vitamin B6.zinc multivitamins omega-3caffeine , theobromine ginkgo biloba