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Primary disorder of vigilance , which is characterized by poor attention and concentration , as well as difficulties staying awake . These children tend to fidget , yawn and stretch and appear to be hyperactive in order to remain alert and active .
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Mood disorders ( especially bipolar disorder and major depressive disorder ) . Boys diagnosed with the combined ADHD subtype are more likely to have a mood disorder . Adults with ADHD sometimes also have bipolar disorder , which requires careful assessment to accurately diagnose and treat both conditions .
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Anxiety disorders have been found to occur more commonly in the ADHD population .
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Obsessive @-@ compulsive disorder ( OCD ) can co @-@ occur with ADHD and shares many of its characteristics .
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Substance use disorders . Adolescents and adults with ADHD are at increased risk of substance abuse . This is most commonly seen with alcohol or cannabis . The reason for this may be an altered reward pathway in the brains of ADHD individuals . This makes the evaluation and treatment of ADHD more difficult , with seri... |
Restless legs syndrome has been found to be more common in those with ADHD and is often due to iron deficiency anaemia . However , restless legs can simply be a part of ADHD and requires careful assessment to differentiate between the two disorders .
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Sleep disorders and ADHD commonly co @-@ exist . They can also occur as a side effect of medications used to treat ADHD . In children with ADHD , insomnia is the most common sleep disorder with behavioral therapy the preferred treatment . Problems with sleep initiation are common among individuals with ADHD but often ... |
There is an association with persistent bed wetting , language delay , and developmental coordination disorder ( DCD ) . Language delays can include auditory processing disorders such as short @-@ term auditory memory weakness , difficulty following instructions , slow speed of processing spoken language , and difficu... |
= = Cause = =
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The cause of most cases of ADHD is unknown ; however , it is believed to involve interactions between genetic and environmental factors . Certain cases are related to previous infection of or trauma to the brain .
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= = = Genetics = = =
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Twin studies indicate that the disorder is often inherited from one 's parents with genetics determining about 75 % of cases . Siblings of children with ADHD are three to four times more likely to develop the disorder than siblings of children without the disorder . Genetic factors are also believed to be involved in ... |
Typically , a number of genes are involved , many of which directly affect dopamine neurotransmission . Those involved with dopamine include DAT , DRD4 , DRD5 , TAAR1 , MAOA , COMT , and DBH . Other genes associated with ADHD include SERT , HTR1B , SNAP25 , GRIN2A , ADRA2A , TPH2 , and BDNF . A common variant of a gen... |
Evolution may have played a role in the high rates of ADHD , particularly hyperactive and impulsive traits in males . Some have hypothesized that some women may be more attracted to males who are risk takers , increasing the frequency of genes that predispose to hyperactivity and impulsivity in the gene pool . Others ... |
People with Down syndrome are more likely to have ADHD .
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= = = Environment = = =
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In addition to genetics , some environmental factors might play a role . Alcohol intake during pregnancy can cause fetal alcohol spectrum disorders which can include ADHD or symptoms like it . Children exposed to certain toxic substances , such as lead or polychlorinated biphenyls , may develop problems which resemble... |
Extreme premature birth , very low birth weight , and extreme neglect , abuse , or social deprivation also increase the risk as do certain infections during pregnancy , at birth , and in early childhood . These infections include , among others , various viruses ( measles , varicella zoster encephalitis , rubella , en... |
Some studies suggest that in a minority of children , artificial food dyes or preservative may be associated with an increased prevalence of ADHD or ADHD @-@ like symptoms but the evidence is weak and may only apply to children with food sensitivities . The United Kingdom and the European Union have put in place regul... |
Research does not support popular beliefs that ADHD is caused by eating too much refined sugar , watching too much television , parenting , poverty or family chaos ; however , they might worsen ADHD symptoms in certain people .
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= = = Society = = =
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The diagnosis of ADHD can represent family dysfunction or a poor educational system rather than an individual problem . Some cases may be explained by increasing academic expectations , with a diagnosis being a method for parents in some countries to get extra financial and educational support for their child . The yo... |
According to social construction theory it is societies that determine the boundary between normal and abnormal behavior . Members of society , including physicians , parents , and teachers , determine which diagnostic criteria are used and , thus , the number of people affected . This leads to the current situation w... |
= = Pathophysiology = =
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Current models of ADHD suggest that it is associated with functional impairments in some of the brain 's neurotransmitter systems , particularly those involving dopamine and norepinephrine . The dopamine and norepinephrine pathways that originate in the ventral tegmental area and locus coeruleus project to diverse reg... |
= = = Brain structure = = =
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In children with ADHD , there is a general reduction of volume in certain brain structures , with a proportionally greater decrease in the volume in the left @-@ sided prefrontal cortex . The posterior parietal cortex also shows thinning in ADHD individuals compared to controls . Other brain structures in the prefront... |
= = = Neurotransmitter pathways = = =
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Previously it was thought that the elevated number of dopamine transporters in people with ADHD was part of the pathophysiology but it appears that the elevated numbers are due to adaptation to exposure to stimulants . Current models involve the mesocorticolimbic dopamine pathway and the locus coeruleus @-@ noradrener... |
= = = Executive function and motivation = = =
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The symptoms of ADHD arise from a deficiency in certain executive functions ( e.g. , attentional control , inhibitory control , and working memory ) . Executive functions are a set of cognitive processes that are required to successfully select and monitor behaviors that facilitate the attainment of one 's chosen goal... |
ADHD has also been associated with motivational deficits in children . Children with ADHD find it difficult to focus on long @-@ term over short @-@ term rewards , and exhibit impulsive behavior for short @-@ term rewards . In these individuals , a large amount of positive reinforcement effectively improves task perfo... |
= = = Intelligence = = =
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Overall , studies have shown that people with ADHD tend to have lower scores on intelligence quotient ( IQ ) tests . The significance of this is controversial due to the differences between people with ADHD and the difficulty determining the influence of symptoms , such as distractibility , on lower scores rather than... |
= = Diagnosis = =
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ADHD is diagnosed by an assessment of a person 's childhood behavioral and mental development , including ruling out the effects of drugs , medications and other medical or psychiatric problems as explanations for the symptoms . It often takes into account feedback from parents and teachers with most diagnoses begun a... |
In North America , DSM @-@ 5 criteria are used for diagnosis , while European countries usually use the ICD @-@ 10 . With the DSM @-@ IV criteria a diagnosis of ADHD is 3 – 4 times more likely than with the ICD @-@ 10 criteria . It is classified as neurodevelopmental psychiatric disorder . Additionally , it is classif... |
Associated conditions that should be screened for include anxiety , depression , oppositional defiant disorder , conduct disorder , and learning and language disorders . Other conditions that should be considered are other neurodevelopmental disorders , tics , and sleep apnea .
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Diagnosis of ADHD using quantitative electroencephalography ( QEEG ) is an ongoing area of investigation , although the value of QEEG in ADHD is currently unclear . In the United States , the Food and Drug Administration has approved the use of QEEG to evaluate the morbidity of ADHD .
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= = = Diagnostic and Statistical Manual = = =
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As with many other psychiatric disorders , formal diagnosis is made by a qualified professional based on a set number of criteria . In the United States , these criteria are defined by the American Psychiatric Association in the DSM . Based on the DSM criteria , there are three sub @-@ types of ADHD :
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ADHD predominantly inattentive type ( ADHD @-@ PI ) presents with symptoms including being easily distracted , forgetful , daydreaming , disorganization , poor concentration , and difficulty completing tasks .
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ADHD , predominantly hyperactive @-@ impulsive type presents with excessive fidgetiness and restlessness , hyperactivity , difficulty waiting and remaining seated , immature behavior ; destructive behaviors may also be present .
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ADHD , combined type is a combination of the first two subtypes .
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This subdivision is based on presence of at least six out of nine long @-@ term ( lasting at least six months ) symptoms of inattention , hyperactivity – impulsivity , or both . To be considered , the symptoms must have appeared by the age of six to twelve and occur in more than one environment ( e.g. at home and at s... |
= = = International Classification of Diseases = = =
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In the ICD @-@ 10 , the symptoms of " hyperkinetic disorder " are analogous to ADHD in the DSM @-@ 5 . When a conduct disorder ( as defined by ICD @-@ 10 ) is present , the condition is referred to as hyperkinetic conduct disorder . Otherwise , the disorder is classified as disturbance of activity and attention , othe... |
= = = Adults = = =
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Adults with ADHD are diagnosed under the same criteria , including that their signs must have been present by the age of six to twelve . Questioning parents or guardians as to how the person behaved and developed as a child may form part of the assessment ; a family history of ADHD also adds weight to a diagnosis . Wh... |
= = = Differential diagnosis = = =
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Symptoms of ADHD such as low mood and poor self @-@ image , mood swings , and irritability can be confused with dysthymia , cyclothymia or bipolar disorder as well as with borderline personality disorder . Some symptoms that are due to anxiety disorders , antisocial personality disorder , developmental disabilities or... |
Primary sleep disorders may affect attention and behavior and the symptoms of ADHD may affect sleep . It is thus recommended that children with ADHD be regularly assessed for sleep problems . Sleepiness in children may result in symptoms ranging from the classic ones of yawning and rubbing the eyes , to hyperactivity ... |
= = Management = =
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The management of ADHD typically involves counseling or medications either alone or in combination . While treatment may improve long @-@ term outcomes , it does not get rid of negative outcomes entirely . Medications used include stimulants , atomoxetine , alpha @-@ 2 adrenergic receptor agonists , and sometimes anti... |
= = = Behavioral therapies = = =
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There is good evidence for the use of behavioral therapies in ADHD and they are the recommended first line treatment in those who have mild symptoms or are preschool @-@ aged . Psychological therapies used include : psychoeducational input , behavior therapy , cognitive behavioral therapy ( CBT ) , interpersonal psych... |
Parent training and education have been found to have short @-@ term benefits . There is little high quality research on the effectiveness of family therapy for ADHD , but the evidence that exists shows that it is similar to community care and better than a placebo . Several ADHD specific support groups exist as infor... |
Training in social skills , behavioral modification and medication may have some limited beneficial effects . The most important factor in reducing later psychological problems , such as major depression , criminality , school failure , and substance use disorders is formation of friendships with people who are not in... |
Regular physical exercise , particularly aerobic exercise , is an effective add @-@ on treatment for ADHD in children and adults , particularly when combined with stimulant medication , although the best intensity and type of aerobic exercise for improving symptoms are not currently known . In particular , the long @-... |
= = = Medication = = =
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Stimulant medications are the pharmaceutical treatment of choice . They have at least some effect in the short term in about 80 % of people . Methylphenidate appears to improve symptoms as reported by teachers and parents .
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There are a number of non @-@ stimulant medications , such as atomoxetine , bupropion , guanfacine , and clonidine that may be used as alternatives , or added to stimulant therapy . There are no good studies comparing the various medications ; however , they appear more or less equal with respect to side effects . Sti... |
Underdosing of stimulants may occur and result in a lack of response or later loss of effectiveness . This is particularly common in adolescents and adults as approved dosing is based on school @-@ aged children , causing some practitioners to use weight based or benefit based off @-@ label dosing instead .
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While stimulants and atomoxetine are usually safe , there are side @-@ effects and contraindications to their use . A large overdose on ADHD stimulants is commonly associated with symptoms such as stimulant psychosis and mania ; although very rare , at therapeutic doses these events appear to occur in approximately 0 ... |
= = = Diet = = =
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