PRESCHOOLERS WITH ADHD
Attention Deficit Hyperactivity Disorder (ADHD) is a neuro-developmental disorder characterized by the presence of early-onset persistent, pervasive and impairing hyperactive-impulsive and/or inattentive symptoms
HOW IS ADHD DIAGNOSED?
1. Several inattentive or hyperactive-impulsive symptoms were present before 12 years old
2. Manifestations of the disorder must be present in more than one setting (e.g. home and school)
3. Clear evidence that the symptoms interfere with or reduce the quality of social, academic, or occupational functioning
4. Symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder
Diagnosis should be made through a thorough clinical assessment.
(American Psychiatric Association, 2013)
TYPES OF ADHD
Combined Presentation
If both inattention criteria and hyperactivity-impulsivity criteria are met for the past 6 months
Predominantly inattentive presentation
If inattention criteria is met but hyperactivity-impulsivity criteria is not met for the past 6 months
Predominantly hyperactive/impulsive presentation
If hyperactivity-impulsivity criteria is met but inattention criteria is not met for the past 6 months
(American Psychiatric Association, 2013)
WHAT IS THE CAUSE?
• Increasing evidence that ADHD is a heritable condition with underlying genetic cause
• Insufficient evidence to implicate an environmental cause
(Thapar, Cooper, Eyre, & Langley, 2013)
RISK AND PROGNOSTIC FACTORS
• Temperamental
- ADHD is associated with reduced behavioural inhibition, effortful control, or constraint; negative emotionality; and/or elevated novelty seeking. These traits may predispose some children to ADHD but are not specific to the disorder.
• Environmental
- Very low birth weight (<1500g) conveys a two to three fold risk for ADHD, but most children with low birth weight do not develop ADHD. Although ADHD is corelated with smoking during pregnancy, some of this association reflects common genetic risk. A minority of cases may be related to reactions to aspects of diet. There may be a history of child abuse, neglect, multiple foster placements, neurotoxin exposure (e.g. lead), infections (e.g. encephalitis), or alcohol exposure in utero. Exposure to environmental toxicants has been correlated with subsquent ADHD, but it is not known whether these associations are causal.
• Genetic and physiological
- ADHD is elevated in the first degree biological relatives of individuals with ADHD. The heritability of ADHD is substantial. While specific genes have been correlated with ADHD, they are neither necessary nor sufficient causal factors. Visual and hearing impairments, metabolic abnormalities, sleep disorders, nutritional deficiencies, and epilepsy should be considered as possible influences on ADHD symptoms.
- ADHD is not associated with specific physical features, although rates of minor physical anomalies (e.g. hypertelorism, highly arched palate, low-set ears) may be relatively elevated. Subtle motor delays and other neurological soft signs may occur.
• Course modifiers
- Family interaction patterns in early childhood are unlikely to cause ADHD but may influence its course or contribute to secondary development of conduct problems.
(American Psychiatric Association, 2013)
HOW FREQUENTLY DOES IT OCCUR?
● Population surveys suggest that ADHD occurs in most cultures in about 5% of children and about 2.5% of adults
● ADHD is more frequent in males than in females in the general population, with a ratio of approximately 2:1 in children and 1.6:1 in adults
● Females are more likely than males to present primarily with inattentive features
● While there has been no epidemiological study on the prevalence of this condition among children in Singapore, a local study reported the prevalence of externalising problems to be 4.9% among Singaporean primary school children
(American Psychiatric Association, 2013)
(Ministry Of Health Singapore, 2014)
(Woo et al., 2007)
WHAT ARE THE LONG TERM OUTCOMES OF THIS GROUP?
● The disorder is relatively stable through early adolescence, but some individuals have a worsened course with development of antisocial behaviors. In most individuals with ADHD, symptoms of motoric hyperactivity become less obvious in adolescence and adulthood, but difficulties with restlessness, inattention, poor planning, and impulsivity persist. A substantial proportion of children with ADHD remain relatively impaired into adulthood.
● ADHD is associated with reduced school performance and academic attainment, social rejection, and, in adults, poorer occupational performance, attainment, attendance, and higher probability of unemployment as well as elevated interpersonal conflict. Children with ADHD are significantly more likely than their peers without ADHD to develop conduct disorder in adolescence and antisocial personality disorder in adulthood, consequently increasing the likelihood for substance use disorders and incarceration. The risk of subsequent substance use disorders is elevated, especially when conduct disorder or antisocial personality disorder develops. Individuals with ADHD are more likely than peers to be injured. Traffic accidents and violations are more frequent in drivers with ADHD. There may be an elevated likelihood of obesity among individuals with ADHD.
● Inadequate or variable self-application to tasks that require sustained effort is often interpreted by others as laziness, irresponsibility, or failure to cooperate. Family relationships may be characterized by discord and negative interactions. Peer relationships are often disrupted by peer rejection, neglect, or teasing of the individual with ADHD. On average, individuals with ADHD obtain less schooling, have poorer vocational achievement, and have reduced intellectual scores than their peers, although there is great variability. In its severe form, the disorder is markedly impairing, affecting social, familial, and scholastic/occupational adjustment.
● Academic deficits, school-related problems, and peer neglect tend to be most associated with elevated symptoms of inattention, whereas peer rejection and, to a lesser extent, accidental injury are most salient with marked symptoms of hyperactivity or impulsivity.
(American Psychiatric Association, 2013)
(Faraone, Biederman, & Mick, 2006)
