Dr R. C. Ibekwe

 Manifests in early childhood with symptoms of hyperactivity, impulsivity, and/or inattention  Symptoms affect cognitive, academic, behavioral, emotional, and social functioning  It is the most common neurobehavioral disorder of childhood, 1 of the most prevalent chronic health conditions affecting school-aged children,

ADHD is characterized by  Inattention, including increased distractibility and difficulty sustaining attention;  Poor impulse control and decreased self- inhibitory capacity  Motor overactivity and motor restlessness  Impairment should present before 7 yr of age  Some impairment from the symptoms is present in 2 or more settings (e.g., at school [or work] or at home)

 Evidence of clinically significant impairment in social, academic, or occupational functioning  Symptoms do not occur exclusively during the course of a pervasive developmental disorder, schizophrenia, or other psychotic disorder, and are not better accounted for by another mental disorder

 No single factor that determines the expression of ADHD  Multiple factors have been implicated in the etiology of ADHD.  Birth complications, such as toxemia, lengthy labor, and complicated delivery. Maternal smoking and alcohol use during pregnancy  Strong genetic component to ADHD, dopamine transporter gene and a particular form of the dopamine 4 receptor gene were implicated

 5–10% of school-aged children are affected  ADHD is more common in boys than girls  ADHD frequently have comorbid psychiatric disorders, including (but not limited to) oppositional defiant disorder, conduct disorder, depression, anxiety disorder, and learning disabilities

 ADHD is a syndrome composed of three categories of symptoms: hyperactivity, impulsivity, and inattention  Hyperactive behavior is identified through excessive fidgetiness or talking, difficulty remaining seated when required to do so  Impulsive behavior is manifested by difficulty waiting turns, blurting out answers too quickly, disruptive classroom behavior  Inattention include forgetfulness, easily distracted, losing or misplacing things, disorganization

 Symptoms must be present in more than one setting (eg, school and home)  Symptoms must persist for at least six months  Symptoms must be present before the age of seven years  Symptoms must impair function in academic, social, or occupational activities  Symptoms must be excessive for the developmental level of the child  Other mental disorders that could account for the symptoms must be excluded

 Learning disabilities  Behavioral and emotional problems such as depression, bipolar disease, anxiety, or post traumatic stress disorder  Sleep disorders, including those secondary to chronic upper airway obstruction from enlarged tonsils and adenoids  Substance abuse may result in declining school performance and inattentive behavior.

 Psychosocial Treatments. set goals for the family to improve the child's interpersonal relationships, develop study skills, and decrease disruptive behaviors.  Behaviorally Oriented Treatments guide the parents and teachers in implementing rules, consequences, and rewards to encourage desired behaviors.  Medications psychostimulant medications, including methylphenidate, amphetamine, and/or various dextroamphetamine preparations

 Neurodevelopmental disorder of unknown etiology, but with a strong genetic basis. It develops and is typically diagnosed before 36 mo of age.  Impairment in the areas of language development or communication skills, social interactions and reciprocity, and imagination and play

 Impaired social interaction is a hallmark of ASD.  Individuals with ASD have impaired ability to use and interpret nonverbal behaviors such as eye-to-eye gaze, facial expression, gestures, and body postures  Fail to develop peer relationships appropriate to their developmental level 

 Lack the spontaneous seeking to share enjoyment, interests, or achievements with other people (ie, impaired joint attention or social referencing)  Lack social or emotional reciprocity  Marked and sustained impairment of communication is the second hallmark of ASD  Delay in, or total lack of, the development of spoken language

 Restricted and repetitive and stereotyped patterns of behavior are the third core symptom of ASD  Preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal in either intensity or focus  Inflexible adherence to specific, nonfunctional routines or rituals

 The exact cause of autism is unknown, but is believed to be multifactorial, with a strong genetic influence  The genetic component of autism is believed to be heterogeneous, attributed to as many as 100 genes,  Various environmental factors have been explored as causative agents in autism  There is no association between the administration of the measles-mumps-rubella vaccine and the development of autism.

 The prevalence rate of all pervasive developmental disorders appears to be 58.7 per 10,000 children. This prevalence rate includes autism (22/10,000)  The incidence of the diagnosis of autism may have increased  The increase in the number of children identified with autism is likely related to changes in the definition of and diagnostic criteria for autism,

 Intensive behavioral therapy, beginning before 3 yr of age and targeted toward speech and language development, is successful in improving both language capacity and later social functioning  Children with autism require alternate educational approaches, even when language capacity is near normal  Unfounded claims of beneficial results from many unproven therapies for autism

 Habit disorders are a heterogenous group of repetitive behaviors that include thumb or digit sucking, teeth grinding (bruxism), skin picking, hair pulling, and head banging.  Involuntary movements or vocalizations (tics) can also be considered habitual behaviors  They are mainly benign disorders and mainly managed by reassurance except when they interfer with the child's physical, emotional, or social functioning.

 Tics are sudden, brief, intermittent movements (motor tics) or utterances (vocal or phonic tics)  Tics have been considered involuntary, but tics can temporarily be voluntarily suppressed  Tics are either simple or complex  Simple tics include blinking, facial grimacing, shoulder shrugging, and head jerking  complex tic involes coordinated movements

 waxes and wanes and is temporarily supressible and there is an irresistible urge before and relief after a tic  Neurological examination is normal except for the presence of tics  Diagnosis is clinical  Management involves mainly supportive by educating patients, parents, teachers and colleague about tics  Drug treatment only when it is interfering with school, job or social interaction