Title: ADHD: Pathophysiology, Management, and Assessment Scales

Authors: Dr Pramesh Dogra, Dr Suman Lata

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i7.58

Abstract

Attention-Deficit/Hyperactivity disorder (ADHD) is the most prevalent childhood behavioural disorder diagnosed in the outpatient setting. Due to the broad impact of ADHD, the disease is likely to have serious economic implications for children and their families leading to increased costs in healthcare. Functional and anatomical dysfunction in the brain's frontal cortex and basal ganglia segments of the cortico-basal ganglia-thalamocortical circuitry have been observed in patients of ADHD. A combination of psycho-education, Cognitive behavioral therapy, and pharmacotherapy with psychostimulants like Methylphenidate are used for the management of ADHD symptoms. Various rating scales help in the assessment of severity of disease, treatment planning, and monitoring the level of improvement.

Keywords: ADHD, assessment scales, Conners' scale, Vanderbilt Scale

References

  1. Sadock BJ, Sadock VA. Attention-Deficit Disorders. In: Sadock BJ, Sadock VA editors, Kaplan and Sadock’s Synopsis of Psychiatry, 10th ed. Philadelphia: Lippincott Williams and Wilkins; 2009. p.1206-1346.
  2. Thomas R, Sanders S, Doust J, Beller E, Glasziou P. Prevalence of attention- deficit/hyperactivity disorder: a systematic review and meta-analysis. Pediatrics. 2015 Apr 1;135(4):e994-1001.
  3. Matza LS, Paramore C, Prasad M. A review of the economic burden of ADHD. Cost effectiveness and resource allocation. 2005 Jun 9;3(1):5.
  4. Richards JM, Plate RC, Ernst M. A systematic review of fMRI reward paradigms used in studies of adolescents vs. adults: the impact of task design and implications for understanding neurodevelo-pment. Neuroscience &Biobehavioral Reviews. 2013 Jun 30;37(5):976-91.
  5. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorder, 5 th ed. Washington, DC: American Psychiatric Publishing; 2013. P. 314-26.
  6. Wilens TE. Mechanism of action of agents used in attention-defi­cit/hyperactivity disorder. J Clin Psychiatry 2006;67:32-8.
  7. Faries DE, Yalcin I, Harder D, Heiligenstein JH. Validation of the ADHD Rating Scale as a clirlician administered and scored instrument. Journal of Attention Disorders. 2001 Sep;5(2):107-15.
  8. Purpura DJ, Lonigan CJ. Conner’s Parent Rating Scale for school children: a revised, brief, age-specific measure. J Clin Child Adolesc Psychol. 2009;38:263-72.
  9. Cohcn M, Becker, M. G., & Campbell, R. Relationships among four Methods of assessment ofchildren with attention deficit-hyperactivity disorder. Journal of School Psychology. 1990;28:189-202.
  10. Conners CK. Clinical use of rating scales in diagnosis and treatment of attention-deficit/hyperactivity disorder. Pediatric Clinics of North America. 1999 Oct 1;46(5):857-70.
  11. Guy W. The Clinical Global Impression Scale. In: ECDEU Assessment Manual for Psychopharmacology-Revised. Rockville. US Dept. of Health, Education and Welfare, ADAMHA, MIMH Psychopharma-cology Research Branch; 1976. p. 218-22
  12. Frodl T, Skokauskas N. Meta‐analysis of structural MRI studies in children and adults with attention deficit hyperactivity disorder indicates treatment effects. Acta Psychiatrica Scandinavica. 2012 Feb 1;125(2):114-26.
  13. Riglin L, Collishaw S, Thapar AK, Dalsgaard S, Langley K, Smith GD, Stergiakouli E, Maughan B, O’Donovan MC, Thapar A. Association of genetic risk variants with attention-deficit/hyperactivity disorder trajectories in the general population. Jama psychiatry. 2016 Dec 1;73(12):1285-92.
  14. Faraone SV, Perlis RH, Doyle AE, Smoller JW, Goralnick JJ, Holmgren MA, Sklar P. Molecular genetics of attention-deficit/hyperactivity disorder. Biological psychiatry. 2005 Jun 1;57(11):1313-23.
  15. Li CS, Sinha R. Inhibitory control and emotional stress regulation: Neuroimaging evidence for frontal–limbic dysfunction in psycho-stimulant addiction. Neuroscience &Biobehavioral Reviews. 2008 Dec 31;32(3):581-97.
  16. Abramovitch A, Dar R, Mittelman A, Wilhelm S. Comorbidity between attention deficit/hyperactivity disorder and obsessive-compulsive disorder across the lifespan: a systematic and critical review. Harvard review of psychiatry. 2015 Jul 1;23(4):245-62.
  17. Danckaerts M, Sonuga-Barke EJ, Banaschewski T, Buitelaar J, Döpfner M, Hollis C, Santosh P, Rothenberger A, Sergeant J, Steinhausen HC, Taylor E. The quality of life of children with attention deficit/hyperactivity disorder: a systematic review. European child & adolescent psychiatry. 2010 Feb 1;19(2):83-105.
  18. Moffitt TE, Caspi A. Childhood predictors differentiate life-course persistent and adolescence-limited antisocial pathways among males and females. Development and psychopathology. 2001 Jun 1;13(02):355-75.
  19. Seixas M, Weiss M, Müller U. Systematic review of national and international guidelines on attention-deficit hyperactivity disorder. Journal of Psychopharmacology. 2012 Jun;26(6):753-65.
  20. Greenhill L, Beyer DH, Finkleson J, Shaffer D, Biederman J, Conners CK, Gillberg C, Huss M, Jensen P, Kennedy JL, Klein R. Guidelines and algorithms for the use of methylphenidate in children with Attention-Deficit/Hyperactivity Disorder. Journal of attention disorders. 2001 Dec;6:S89-100.
  21. Schabram I, Henkel K, Mohammadkhani Shali S, Dietrich C, Schmaljohann J, Winz O, Prinz S, Rademacher L, Neumaier B, Felzen M, Kumakura Y, Cumming P, Mottaghy FM, Gründer G, Vernaleken I. Acute and sustained effects of methylphenidate on cognition and presynaptic dopamine metabolism: an [18F]FDOPA PET study.J Neurosci. 2014 Oct 29;34(44):14769-76.
  22. Durston S. A review of the biological basIs of ADHD: what have we learned from imaging studies. Mental retardation and developmental disabilities research reviews. 2003 Jan 1;9(3):184-95.
  23. Ibrahim K, Donyai P. Drug holidays from ADHD medication: international experience over the past four decades. Journal of attention disorders. 2015 Jul;19(7):551-68.
  24. Ibrahim K, Vogt C, Donyai P. Caught in the eye of the storm: a qualitative study of views and experiences of planned drug holidays from methylphenidate in child and adolescent ADHD treatment. Child and Adolescent Mental Health. 2016 Nov 1;21(4):192-200.
  25. Bange F, Le Heuzey MF, Acquaviva E, Delorme R, Mouren MC. Cardiovascular risks and management during Attention Deficit Hyperactivity Disorder treatment with methylphenidate. Archives de pediatrie: organeofficiel de la Societefrancaise de pediatrie. 2014 Jan;21(1):108-12.
  26. Negrao BL, Crafford D, Viljoen M. The effect of sympathomimetic medication on cardiovascular functioning of children with attention-deficit/hyperactivity disorder: cardiovascular topic. Cardiovascular journal of Africa. 2009 Sep 1;20(5):296-9.
  27. Zhang S, Faries DE, Vowles M, Michelson D. ADHD rating scale IV: psychometric properties from a multinational study as clinician‐administered instrument. Internat-ional journal of methods in psychiatric research. 2005 Dec 1;14(4):186-201.
  28. Conners CK, Sitarenios G, Parker JD, Epstein JN. The revised Conners' Parent Rating Scale (CPRS-R): factor structure, reliability, and criterion validity. Journal of abnormal child psychology. 1998 Aug 1;26(4):257-68.
  29. Parker JD, Sitarenios G, Conners CK. Abbreviated Conners' Rating Scales revisited: A confirmatory factor analytic study. Journal of Attention Disorders. 1996 Apr 1;1(1):55-62.
  30. Andrade ÊR, Scheuer C. Analysis of the methylphenidate's efficacy using the abbreviated version Conners' questionnaire in attention deficit hyperactivity disorder. Arquivos de neuro-psiquiatria. 2004 Mar;62(1):81-5.
  31. Yuki K, Bhagia J, Mrazek D, Jensen PS. How does a real-world child psychiatric clinic diagnose and treat attention deficit hyperactivity disorder?. World journal of psychiatry. 2016 Mar 22;6(1):118.
  32. Leslie LK, Weckerly J, Plemmons D, Landsverk J, Eastman S. Implementing the American Academy of Pediatrics attention-deficit/hyperactivity disorder diagnostic guidelines in primary care settings. Pediatrics. 2004 Jul 1;114(1):129-40.
  33. Collett BR, Ohan JL, Myers KM. Ten-year review of rating scales. V: scales assessing attention-deficit/hyperactivity disorder. Journal of the American Academy of Child & Adolescent Psychiatry. 2003 Sep 30;42(9):1015-37.
  34. Park JI, Shim SH, Lee M, Jung YE, Park TW, Park SH, Im YJ, Yang JC, Chung YC, Chung SK. The validities and efficiencies of Korean ADHD rating scale and korean child behavior checklist for screening children with ADHD in the community. Psychiatry investigation. 2014 Jul 1;11(3):258-65.
  35. Ni HC, Lin YJ, Gau SS, Huang HC, Yang LK. An open-label, randomized trial of methylphenidate and atomoxetine treatment in adults with ADHD. Journal of attention disorders. 2017 Jan;21(1):27-39.
  36. Wender PH, Reimherr FW, Marchant BK, Sanford ME, Czajkowski LA, Tomb DA. A one year trial of methylphenidate in the treatment of ADHD. Journal of Attention Disorders. 2011 Jan;15(1):36-45.

Corresponding Author

Dr Pramesh Dogra

Medical Officer, Directorate of Health Services, Department of Health and Family Welfare

Govt. of Himachal Pradesh, SDA Complex, Kasumpti, Shimla - 171001, India

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