Attention Deficit Hyperactivity Disorder Handbook: A Physician's Guide to ADHD

191 Pages·2011·2.03 MB·English

by  J. Gordon Millichap (auth.)

Attention Deficit Hyperactivity Disorder Handbook
J. Gordon Millichap
Attention Deficit
Hyperactivity Disorder
Handbook
A Physician’s Guide to ADHD
Second Edition
123
J.GordonMillichap,MD
PediatricNeurologist
Children’sMemorialHospital
NorthwesternUniversityMedicalSchool
Chicago,Illinois
USA
ISBN978-1-4419-1396-8 e-ISBN978-1-4419-1397-5
DOI10.1007/978-1-4419-1397-5
SpringerNewYorkDordrechtHeidelbergLondon
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andJohn
Preface
ADHD,orattentiondeficithyperactivitydisorder,isasyndromecommonlyencoun-
tered in children and adolescents, and occasionally in adults. It is often associated
with learning disabilities, resulting in failure to achieve the expected level of aca-
demicperformance.Atleastonechildineveryclassroomandapproximately3–5%
oftheschool-agepopulationisinattentive,hyperactive,orboth.Thecauseisdiverse
and often undetermined; genetic and environmental factors are invoked. A family
member,eitherparentorsibling,hasahistoryofADHDinanestimated80%,and
minoranomaliesofbraindevelopment,prematurebirthandanoxicinjury,infection,
andtoxicnicotineandleadexposurearesomeofthepresumedcauses.Aneurolog-
ical basis for ADHD is supported by reports of MRI evidence of structural brain
abnormalities,electroencephalographicdysrhythmias,andsubtlesignsofimmature
braindevelopmentonneurologicalexamination.
Parents may recognize hyperactive behavior soon after birth or when the child
beginstowalk,butthediagnosisisfrequentlydelayeduntilateacherobservesthe
inability to focus, distractibility, and restless behavior in the classroom. An initial
evaluationbythepediatricianorfamilyphysicianisusuallyfollowedbyconsulta-
tionswiththepediatricneurologistorpsychiatrist,apsychologicalevaluation,and
laboratoryinvestigationswhenindicated.
Treatmentconsistsofeducationalaccommodations,medications,behaviormod-
ification, and family counseling. Central nervous stimulants have a remarkable
beneficial effect in 80% of ADHD children, helping them to focus, reducing dis-
tractibility and restless behavior, and facilitating learning and memory. Used in
conservative doses, as an aid to education, and monitored closely by a physi-
cian,stimulantmedicationsarefreefromserioussideeffects.Alternativetherapies,
includingdiet,andvisualandauditorytraining,maybesupportivebutrarelyhave
theimmediateandmeasurableeffectsofpharmacotherapy.
Thisbookiswrittenforthepracticingpediatrician,andresidentsandfellowsin
pediatrics,pediatricneurology,neurology,andpsychiatry.Thepsychologist,social
worker, therapist, the interested teacher and student, and concerned and informed
parents should also find the book of value. This Attention Deficit Hyperactivity
Disorder Handbook is an expanded professional, updated edition and revision,
incorporatingadvancesinthelastdecade.Morethanonehundrednewreferences,
vii
viii Preface
manyrelatedtocausesandtreatmentofADHD,areincluded.Questionsmostfre-
quentlyaskedbyparentsandteacherswhocareforthechildwithattentiondeficit
and related disorders are addressed. The methods of management and selection of
medicationsaresupportedwhenpossiblebypublishedreportsofcontrolledstudies.
Referencesarelistedforallpublications.
Thereadershouldbeabletoevaluatethecurrentextentofourknowledgeofdiag-
nosis,treatmentmethods,andoutcomeofchildrenwithADHD.Itishopedthatthe
bookwillleadtoabetterunderstandingofthechildwithADHDandimprovement
inthemedical,educational,andpsychologicalmanagement.
Chicago,Illinois J.GordonMillichap,M.D.,F.R.C.P.
Acknowledgments
My patients, many of whom have overcome or compensated for their attention
deficits and are leading successful adult lives, and their parents, who nurture and
support them through difficult times, are the inspiration for this book. My asso-
ciate,nursepractitionerMichelleYee,whosharesthechallengeandsatisfactionin
caring for and helping our patients to achieve in school. Colleagues in pediatrics
and other medical disciplines, who refer patients for neurological evaluation. The
teachers, who facilitate and monitor their students’ responses to therapy. The psy-
chologists, who evaluate and provide child and family counseling, without which
themedicalmanagementofourpatientswouldbeincomplete.Myfriend,Dr.Terry
Finnandson,MartinMillichap,whoreadthemanuscriptandmadehelpfulsugges-
tionsregardingthepsychologist’sroleinthemanagementofADHD.Mysons,Paul,
GordonandDr.JohnMillichap,whoadvisedonvariousaspectsoftheproject,and
mylatewife,Nancy,teacherandauthorofabookondyslexia,whoencouragedme
tocontinueaninterestinattentiondeficitandlearningdisorders.
Iamindebtedtoall.
J.GordonMillichap
ix
Contents
1 DefinitionandHistoryofADHD . . . . . . . . . . . . . . . . . . . 1
BrainDamageSyndromes . . . . . . . . . . . . . . . . . . . . . . . . 1
AlternativeTermsforADHD . . . . . . . . . . . . . . . . . . . . . . 2
EvolutionofPresentConceptofADHD . . . . . . . . . . . . . . . . 2
DiagnosticCriteriaforADHDSubtypes . . . . . . . . . . . . . . . . 3
FurtherDiagnosticCriteria . . . . . . . . . . . . . . . . . . . . . . . 3
ADHD,aContinuumorMedicalSyndrome . . . . . . . . . . . . . . 4
ADHD,aMedicalDeficitorSocialDeviance . . . . . . . . . . . . . . 4
PrevalenceofADHDandGenderFactor . . . . . . . . . . . . . . . . 5
AgeofOnsetofADHD . . . . . . . . . . . . . . . . . . . . . . . . . 5
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
2 CausativeFactors . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
EtiologicalClassification . . . . . . . . . . . . . . . . . . . . . . . . 9
EvidenceforaNeurologicalBasisforADHD . . . . . . . . . . . . . 10
RoleofGeneticFactorsinEtiologyofADHD . . . . . . . . . . . . . 12
ChromosomalAnomaliesAssociatedwithADHD . . . . . . . . . . . 14
MolecularGeneticStudies . . . . . . . . . . . . . . . . . . . . . . . . 14
EnvironmentalFactorsinEtiology . . . . . . . . . . . . . . . . . . . 14
RoleofAdverseHomeandSchoolEnvironments . . . . . . . . . . . 15
ADHDinAdoptedChildren . . . . . . . . . . . . . . . . . . . . . . . 15
BiochemicalBasisforADHD . . . . . . . . . . . . . . . . . . . . . . 16
InfectiousCausesofADHD . . . . . . . . . . . . . . . . . . . . . . . 16
PerinatalandEarly-LifeRiskFactors . . . . . . . . . . . . . . . . . . 16
PostnatalRiskFactors . . . . . . . . . . . . . . . . . . . . . . . . . . 17
HeadInjuryasaCauseofADHDandLearningDisorders . . . . . . . 17
HypoglycemiaandADHD. . . . . . . . . . . . . . . . . . . . . . . . 18
RoleofSugarandOtherDietaryFactorsinADHD . . . . . . . . . . . 18
FeingoldTheoryofFoodAdditivesasaCauseofADHD . . . . . . . 19
RoleofFoodAllergyinADHD . . . . . . . . . . . . . . . . . . . . . 20
IronDeficiencyandADHD . . . . . . . . . . . . . . . . . . . . . . . 20
RoleofZincinADHD. . . . . . . . . . . . . . . . . . . . . . . . . . 21
xi
xii Contents
IodineDeficiency,ThyroidFunctionandADHD . . . . . . . . . . . . 21
LeadExposureasaCauseofADHD . . . . . . . . . . . . . . . . . . 22
Cocaine-ExposedInfantsatRiskofADHD . . . . . . . . . . . . . . . 23
Fetal Exposure to Alcohol, Marijuana, or Cigarettes
andIncreasedRiskofADHD . . . . . . . . . . . . . . . . . . . . . . 24
PCBsandOtherEnvironmentalToxinsasPotentialCausesofADHD . 24
RoleofDietDuringInfancyintheCauseofADHD . . . . . . . . . . 26
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
3 SymptomsandSignsofADHD . . . . . . . . . . . . . . . . . . . . 31
Occasional “Inattentiveness” or an “Attention Deficit
Disorder”? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
MeasurementofAttention . . . . . . . . . . . . . . . . . . . . . . . . 32
WhenIsHyperactivityAbnormal? . . . . . . . . . . . . . . . . . . . 33
DevicesUsedtoMeasureMotorActivity . . . . . . . . . . . . . . . . 33
“Subtle”or“Soft”NeurologicalSigns . . . . . . . . . . . . . . . . . 34
DevelopmentalCoordinationDisorderDiagnosticCriteria . . . . . . . 36
RelationBetweenMotorPerformanceandADHD . . . . . . . . . . . 37
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
4 DiagnosisandLaboratoryTests . . . . . . . . . . . . . . . . . . . . 39
SignificanceofHistoryandExamination . . . . . . . . . . . . . . . . 39
QuestionsAskedofParentinMakingADHDDiagnosis . . . . . . . . 40
PhysicalandNeurologicalExaminations . . . . . . . . . . . . . . . . 40
IndicationsforanEEGinChildrenwithADHD . . . . . . . . . . . . 41
IndicationsforanMRIorCTScaninaChildwithADHD . . . . . . . 41
BloodTestsSometimesIndicatedinADHD . . . . . . . . . . . . . . 41
IndicationsforElectrocardiogramand/orCardiacConsult . . . . . . . 42
TestsofResearchInterestOnly . . . . . . . . . . . . . . . . . . . . . 43
EarlyRiskFactorsforaDiagnosisofADHDinChildhood . . . . . . 43
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
5 Oppositional,Conduct,andOtherADHDComorbidDisorders . . 47
OppositionalDefiantDisorder . . . . . . . . . . . . . . . . . . . . . . 47
ConductDisorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
MoodDisorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
AnxietyDisorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Prevalence of Psychiatric Disorders Among Children
withADHD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Relation Between Oppositional Defiant and Conduct
DisordersandADHD . . . . . . . . . . . . . . . . . . . . . . . . . . 50
FactorsThatPredisposetoConductDisordersinChildren
withADHD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50