Attention deficit disorder in childhood

Attention deficit disorder refers to a syndrome of pervasive inattention, impulsivity, and hyperactivity that is found in between 3 and 6 per cent of the population. It is commonly associated with conduct disorders and learning disabilities. The etiology of ADD is unknown, but family and adoption studies demonstrate an important role for genetic transmission. Pre- or postnatal central nervous system damage is suggested in only a few cases. Animal models as well as pharmacologic and clinical studies point to abnormalities in the catecholamine system, particularly dopamine function. Although certain psychometric tests are suggestive, no single laboratory marker is specific to ADD, and information from several sources is usually necessary before reaching the diagnosis. These sources may include parents, teachers, and pediatric psychology consultation, as well as clinical interview and physical examination. Children with ADD often suffer ridicule or rejection from family members, teachers, and peers. Treatment may interrupt the cycle of negative reinforcement that can have devastating effects on the self and public image of the child. Educational and behavioral management are the first line of intervention. Pharmacotherapy is also often helpful with stimulants considered the drugs of choice. Methylphenidate may be administered at a dose of 0.3 to 0.6 mg/kg in the morning. This dose may be repeated at noon. D-amphetamine at approximately half this dose is usually equally effective. Other medications such as the antidepressants and clonidine have proven to be effective in the treatment of ADD and may play a role in the management of some children.