ATTENTION DEFICIT HYPERACTIVITY DISORDERS

• Attention Deficit Disorder: A relatively common neurodevelopmental disorder that presents in childhood with symptoms such as impulsivity, hyperactivity, and inattention. A core feature of this disorder is that symptoms must impair social, occupational, or academic performance. The onset occurs before the age of 7 years and a large majority of patients exhibit symptoms by the 4th year of age. Attention deficit disorder is of four clinical types, hyperactivity, without hyperactivity, residual type, and conduct disorder
• Attention deficit disorder with hyperactivity (Hyperkinetic disorder/ ADHD) is the commonest type
• Attention deficit disorder without hyperactivity is a rare disorder with similar features of ADHD without hyperactivity
• Residual type – Usually diagnosed in adulthood, with the presence of few residual features in adult life
• It occurs in about 3% of school-age children and males are 6-8 times more often affected

• Multifactorial disorder

• The general mechanism is hypothesized to be related to altered catecholamine metabolism

• Genetic predisposition: family history of ADHD, polymorphisms of the dopamine, serotonin, or glutamate receptor subtypes

• Environmental factors: prematurity, in-utero exposure to alcohol

• A subset of patients may have symptoms that are susceptible to dietary factors (e.g., food additives, food sensitivities, mineral deficiencies, sugar)

Poor attention span with distractibility

• Fails to finish the things started
• Shifts from one uncompleted activity to another
• Doesn’t seems to listen
• Easily distracted by external stimuli
• Often loses things

Hyperactivity

• Fidgety 
• Difficulty in sitting still at one place for long
• Moving about here and there 
• Talks excessively 
• Interference in other peoples activities

Impulsivity

• Acts before thinking
• Difficulty in waiting for a turn at work or play

Symptoms present in ≥ 2 settings (e.g., school, home, work)

Interfere with important levels of functioning (e.g., school or work)

Diffrential Diagnosis 

• Bipolar I disorder: more waxing and waning of symptoms
• Mania: Irritability may be more common than Euphoria
• Learning Disorders: Inability to do maths and read is not because of inattention
• Depressive disorders: Distinguished by Hypo activity and withdrawal
• Anxiety disorder: manifested by overactivity and easy distractibility
• Disorders that may mimic ADHD (e.g. hearing or a visual impairment, thyroid disorders, sleep disorders)

Made on the basis of

• Teacher’s school report
• Parents report
• Clinical examination (mental retardation should be excluded, as hyperactivity is a common symptom in MR)
• Conner’s ADHD rating scale is used to assess the severity

Diagnosis of ADHD involves identifying comorbid disorders (e.g.learning disability, psychiatric disorders)

• Behavioural interventions
• Socio-educational measures 
• Behavioural parent training: Teaches parents how to understand and manage their child's condition, how to manage problematic situations, and how to support positive behaviour using operant conditioning
• Operant conditioning: an approach in which the desired behaviour is modified by positive reinforcement (reward) or negative reinforcement (absence of punishment)
• Lack of attention and hyperactivity suggest the involvement of vata 
• if impulsivity is aasociated, pitta anubandha is considered
• Ensure Agni deepthi and Vata anulomana

Snehana

• Kalyanaka gritha, Thiktaka gritha, Mahakalyanaka gritha, Kooshmanda Swarasa gritha
  • Up to 1 years: given as drops: always one should have a proper assessment of agni before administering sneha kalpana -2 drops to 5 drops depending on agni
  • Above 1 year: always start with a minimum dose- even 2 drops will be sufficient to get the desired effect
  • Properly monitor the status of agni and increase the dose

Procedures

• Taila dhara – Shudha bala Taila
• Sirolepa – reduces hyperactivity and impulsivity
• Siropichu – ksheerabala / chandanadi taila 
• Yoga Procedures