DefinePK

Abstract

Introduction


Attention Deficit Hyperactivity Disorder (ADHD) is one of the most frequently diagnosed psychiatric disorders in children, with studies in the West reporting a prevalence of 10-20% in school-aged children.1,2 No figures are available for Pakistan; however, a study 3 in neighbouring India reports a prevalence of 8.1% among children referred to the Psychology outpatient department of a tertiary care hospital. ADHD is defined as developmentally inappropriate poor attention span or age inappropriate hyperactivity and impulsivity or both.4 To meet the diagnostic criteria, the symptoms must appear in at least two contexts, be present for six or more months, occur before 7 years of age and there should be significant social or functional impairment.5 Subtypes include predominantly attention deficit (AD), predominantly hyperactive or impulsive (HI) and combined type (CT). According to various studies, differences have been found in the subtypes regarding age of presentation 6,7 and functional impairment8,9 including behavioural problems, peer interaction and academic performance. The disorder presents more often in boys than in girls (3-5:1)8,10 and usually affects first-born boys. The onset is usually by three years of age but the diagnosis is not made until the child is in elementary school.4 Despite the lack of a specific neurophysiological or neurochemical basis for ADHD, it is predictably associated with conditions causing minimal brain damage.4 Hence, risk factors for the development of ADHD may include any prenatal, perinatal and postnatal problem that can be associated with brain damage. Serious head injuries, meningitis, hydrocephalus, and brain surgery can also increase the risk of developing ADHD.11ADHD often accompanies another developmental disability and its presence should be considered a marker for other developmental or psychiatric conditions.11 An Indian study found 40% of children with ADHD to have some comorbid disorder.3 Comorbid conditions include Oppositional Defiant Disorder (ODD), Conduct Disorder (CD) and affective, anxiety and learning disorders.12 Most children with ADHD can be diagnosed confidently and managed optimally without any biomedical investigations or procedures. The mainstay of any pediatric evaluation of ADHD continues to be a meticulous history.11 This study reports local experience of ADHD.