ATTENTION DEFICIT HYPERACTIVITY (ADD)

Disorder, attention deficit hyperactivity disorder (ADHD) is a behavioral syndrome with neurobiological bases and a strong genetic component. It is a very prevalent disorder estimated to affect between 5% and 10% of child population, being about 3 times more frequent in varones.No have shown differences between different geographical areas, cultural groups or levels socioeconomic. Represents between 20% and 40% of consultations in the services of child and adolescent psychiatry. It is a neurological disorder behavior  characterized by moderate to severe distractibility, short attention span, restlessness, emotional instability and impulsive behaviors. It has a very high response to treatment, even if accompanied by high rates of psychiatric comorbidity. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV): "Typically, symptoms worsen in situations that require attention or sustained mental effort or that lack intrinsic appeal or novelty (eg., Listen to teacher in class, do homework, listen to or read long texts, or working on monotonous or repetitive tasks). " This neurobiological dysfunction was first recognized in childhood. However, to the extent that it was better understood, recognized its chronic nature, since it persists and manifests itself beyond adolescence. Studies of long-term monitoring has shown that between 60% and 75% of children with ADHD continues to have symptoms into adulthood. Historically, this disorder has been given different characterizations and countless denominations, which makes the queries in the literature (see table). It added that the acronym ADHD (Attention-Deficit Hyperactivity Disorder) is widely used to refer to this syndrome.

causes

 is a neurobehavioral disorder of primarily genetic origin. Have demonstrated hereditary factors (ie, inherited, not acquired in the course of life) in 80% of cases. Studies show that there is a familial transmission of the disorder.  In contrast, note that the estimated contribution of non-hereditary factors in all cases of ADHD is only 20%. To explain this minority of cases proposed intervention are multifactorial, involving genetic factors but also in combination with environmental factors. The influence of congenital causes act during gestation (ie, not inherited, with the participation of genetic or environmental factors in varying proportions), such as in utero exposure to nicotine, are not considered as important as a few decades ago. It is noteworthy that even in cases that at first glance be attributed to environmental factors (such as just mentioned), the intervention of purely genetic factor offers a plausible explanation. In that sense, it has been established that smoking rates among women with ADHD are several times higher than in the general population. And because of this, these women are also more likely to smoke during pregnancy as a corollary, the presence of ADHD in children to be born again refers to genetic factors.

Diagnosis

As mentioned earlier, the classification integrates ADHD Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) American Psychiatric Association (APA). It falls within the group of disorders known as childhood-onset, childhood or adolescence and, in particular in the kind of attention deficit disorders and behavior disorders. Under the above, ADHD is an entity that refers to a disorder. Overall, and consistent with the conceptual model of the manual, the term "disorder" aims to define a clinically significant behavioral pattern associated with an upset, a disability or a significantly increased risk of pain, disability or loss of freedom.  

The main features of ADHD are, firstly, the difficulty sustaining concentration (attention deficit), especially in circumstances that offer low stimulation and, secondly, the lack of inhibition or cognitive control over impulses, often associated with motor restlessness (hyperactivity-impulsivity). These two sets of signs may occur singly or in combination. In this regard, recognizes three subtypes of ADHD: With prevalence of attention deficit. (ICD-10 code: F98.8) Predominantly impulsive behavior and hyperactivity. (ICD-10 code: F90.0) Combined type, where the two previous conditions occur simultaneously. (ICD-10 code: F90.0) Standard criteria of DSM-IV set clinical standards for diagnosis of ADHD and for each subtype, according to the presence of a number of symptoms and degree of intensity. The most common subtype is the combination of disorders with hyperactivity and impulsivity (60%). The cigars are less common subtypes (deficits in attention, 30%, hyperactivity and impulsivity, 10%). For the moment, "no laboratory tests that have been established as diagnostic in the clinical assessment of attention deficit disorder with hyperactivity."

Treatment
ADHD symptoms express a biological problem and therefore addressed more effectively with drug treatment, which is still the most important pillar of therapy. Standard treatments rely on stimulants paradoxically, of which very soon showed that positively modify the symptoms. These include caffeine and nicotine, which sometimes adolescents and adults self-medicate. The ideal first report endorsing the use of psychostimulants dates back to 1937, when Charles Bradley established the efficacy and safety of amphetamine sulphate for the treatment of hyperactive children.

Currently, the most commonly used substances in the United States are methylphenidate (the active ingredient behind the trade name Ritalin) and d, l-amphetamine (Adderall), followed by dexamphetamine (Dexedrine) and methamphetamine. Other psychostimulants, second-line treatment of ADHD are pemoline (Cylert) and modafinil (Modiodal). In recent years, the immediate effect drugs tend to be replaced by other preparations, with the same active ingredients, achieve a longer effect, improving the quality of life of those affected, especially schoolchildren. Respect of modafinil, its effectiveness was proven and was about to jump into the market to treat ADHD. However, never reach the pharmacy shelves. Having completed Phase III clinical trials for U.S. approval for this indication, 21 October 2005 the Food and Drug Administration (FDA) accepted the application to market Sparlon (modafinil) for the treatment of ADHD in children and adolescents 6 to 17 years. Expected to launch early 2006.  However, on 8 September of that year, the FDA finally decided to deny approval and requested further studies concerning the drug's safety. In response, Cephalon announced he was leaving product development. However, the incident served to establish the efficacy of modafinil to treat the disorder, which was validated