 It is a persistent pattern of inattention &/or hyperactivity-

impulsivity that is more frequent & severe than is

typically observed in individuals at a comparable level of
development
 Highly distractible
 Motor activity is excessive, random & impulsive.
 4 to 9 : 1
 3 to 7% in school children
1. ADHD, Combined type
 Most children have this type
 At least 6 symptoms of inattention & at least 6 symptoms of
hyperactivity-impulsivity persisted for at least 6 months

2. ADHD, Predominantly inactive type

 At least 6 symptoms of inattention
 Fewer than 6 symptoms of hyperactivity-impulsivity for at
least 6 months
3. ADHD, Predominantly hyperactive-impulsive type
 If at least 6 symptoms of hyperactivity-
impulsivity
 Fewer than 6 symptoms of inattention for at least
6 months
 Genetics:
 Hyperactive parents in their childhood
 If h/o sibling with hyperactivity
 If one of the twin is hyperactive
 An elevation in the catecholamines like dopamine &
norepinephrine
 Prenatal, perinatal & postnatal factors:
 Maternal Smoking
 Intrauterine exposure to toxic substances including alcohol
 Prematurity, signs of fetal distress, prolonged labor
 Perinatal asphyxia & low apgar score
 CP,epilepsy, CNS abnormalities from trauma, infection etc..
 Psychological influences
 Disruption in family
 Psychosocial stress, maternal mental disorder
 Paternal criminality, low socio-economic status
 h/o alcoholism in family
 Difficulties in age-appropriate tasks
 Highly distractible & extremely limited attention spans.
 Shift from one activity to other
 Impulsivity is common
 Difficulty in satisfactory IPR
 Behaviors that inhibit social interaction
 Difficulty in complying social norms
 Some are very aggressive & others regressive & immature
behaviors
 Low frustration tolerance
 Excessive levels of activity, restlessness &
fidgetting(small movements)
 Known as “perpetual motion machines”
 Experience greater no. of accidents.
1. Inattention:
1. Often fails to give close attention to details or makes
careless mistakes in school work, work, or other
activities
2. Often has difficulty sustaining attention in tasks or
play activities
3. Often does not seem to listen when spoken to directly
4. Often does not follow through on instructions & fails
to finish schoolwork, chores, or duties in the
workplace
5. Often has difficulty organizing tasks & activities

6. Often avoids , dislikes, or is reluctant to engage

in tasks that require sustained mental effort

7. Often loses things necessary for tasks or

activities

8. Is often easily distracted by extraneous stimuli

9. Is often forgetful in daily activities

2. Hyperactivity

1. Often fidgets with hands or feet

2. Often leaves seat in classroom

3. Often runs about or climbs excessively in situations in

which it is inappropriate

4. Often has difficulty playing or engaging in leisure

activities quietly

5. Is often “on the go” or often acts as if “driven by a motor”

6. Often talks excessively

 Impulsivity

a. Often blurts out answers before questions have

been completed

b. Often has difficulty waiting turn

c. Often interrupts or intrudes on others

 Risk for injury r/t impulsive & accident prone behavior

 Impaired social interaction r/t intrusive & immature behavior

 Low self esteem r/t dysfunctional family system & negative feedback

 Non compliances with task expectations r/t low frustration tolerance

& short attention span
 Ensure safe environment
 Identify behaviors that put them in risk
 Explain consequences
 Provide supervision & assistance
 Develop trusting relationship with the child
 Discuss which behaviors are not acceptable & their
consequences
 Provide group situations for client as behaviors are
learnt from peer feedback
 Ensure that goals are realistic
 Plan activities that provide success
 Convey unconditional acceptance & positive regard
 Offer recognition of successful & positive attempts
made.
 Provide a environment of task & distraction free
 Provide assistance on 1-1 basis with simple instructions
 Ask to repeat instructions
 Establish goals to complete a part of task , rewarding each step
– completion with a break for physical activity
 Gradually decrease assistance, while assuring that assistance is
still available if needed
 Central nervous stimulants like Dextroamphetamine,
Methylphenidate, Pemoline for increasing attention span, control
of hyperactive behavior & improvement in learning ability

 If they are ineffective or produces too many side effects,

antidepressants like Bupropion & imipramine are given

 ECG should be performed before initiation of therapy

 Dextroamphetamine: PO (3-5yrs): 2.5mg/day

 Methylphenidate: PO(age 6 & older): 5mg/day before BF &

lunch.

 Pemoline : PO(6 & older): initial 37.5mg/day

 Bupropion : PO (6 & older age): 3mg/kg/day

 Imipramine: PO(6 & older): 1mg/kg/day

 Asses mental status: mood, level of activity, aggressiveness
 Ensure client is protected from injury
 Medication after meals & weighing daily - anorexia
 Last dose 6hrs before sleep to prevent insomnia
 Ensure the drug is not discontinued(pemoline) for lack of
immediate results
 Inform to avoid over the counter medications – toxic effect
 Ensure not to withdraw drugs abruptly