Attention Deficit Hyperactivity Disorder: Diagnosis and Management

Vitharon Boon-yasidhi

:
.*

attention-deficit hyperactivity disorder (ADHD)
3
1) 2) 3)

2555; 57(4): 373-386

*

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Vol. 57 No. 4 October - December 2012

373

Attention Deficit Hyperactivity Disorder:

Diagnosis and Management
Vitharon Boon-yasidhi M.D.*

ABSTRACT

Attention-deficit hyperactivity disorder (ADHD) is a common psychiatric disorder
in childhood characterized by three clusters of symptoms: inattention, hyperactivity,
and impulsivity. At least half of children with ADHD have impairing symptoms persisting
to their adolescence or adulthood. The symptoms, particularly if not adequately treated,
can have significant negative impacts on the patients school, family, and social
functioning. Treatment of this condition should include a multi-modal approach, involving
parent education, psychological interventions, educational intervention, and
appropriate use of medications. This article provides a general overview and evidence
based guidelines on the diagnosis and management of ADHD in children and
adolescents.
Keywords: Attention-deficit Hyperactivity Disorder (ADHD), guidelines

J Psychiatr Assoc Thailand 2012; 57(4): 373-386

* Division of Child and Adolescent Psychiatry, Department of Pediatrics, Faculty of Medicine
Siriraj Hospital

374

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Attention Deficit Hyperactivity Disorder: Diagnosis and Management

Attention-deficit hyperactivity
disorder (ADHD)

3 1)
(inattention) 2)
(hyperactivity) 3)
(impulsivity)

1



2



3 4

(worldwide-pooled prevalence)
5.295

5.01 6
10
500,000
40-50
2
3:17

Vitharon Boon-yasidhi

dopamine 4 and 5 receptor gene, dopamine

transporter gene, dopamine beta-hydroxylase
gene, serotonin transporter gene8

9,10



11

prefrontal cortex, basal ganglia,
cerebellum
12

executive function motivation
dopamine
noradrenaline prefrontal
cortex striatum13,14

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1. (inattention)

2. (hyperactivity)

3. (impulsivity)






15

376

60-85
40-50
16

oppositional defiant disorder, conduct disorder,
anxiety disorder depressive disorder learning
disorder tic disorder17

Diagnostic
and Statistical Manual of Mental Disorders, Fourth
Edition-Text Revised (DSM-IV-TR)1
/ -


2

7
( 1)

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Attention Deficit Hyperactivity Disorder: Diagnosis and Management

Vitharon Boon-yasidhi

1
Diagnostic and Statistical Manual of
Mental Disorders, Text Revision, 4th Edition (DSM IV-TR)
A. 6
6 (inattention) / -
(hyperactivity-impulsivity)
(inattention)
1.
2.
3.
4. ()
5.
6. ( )
7. ( )
8.
9.
- (hyperactivity-impulsivity)
1.
2.
3. ()
4.
5.
6.
7.
8.
9.
B. 7
C. 2
D.
E. pervasive developmental disorder, psychotic disorder,
mood disorder, anxiety disorder, dissociative disorder personality disorder
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders,
4th ed (text rev). Washington, DC: American Psychiatric Association, 2000

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Vol. 57 No. 4 October - December 2012

377

2

1.
2.
3.
4.
5.
6.

phenobarbital theophylline
mental retardation, learning disorder, autistic disorder, oppositional defiant disorder,
conduct disorder, adjustment disorder, anxiety disorder, mood disorder

DSM-IV-TR
3

1. inattentive subtype
6
/ 6
2. hyperactive-impulsive subtype
/ 6
6
3. combined subtype
6
/ 6


217,18

378

19

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Attention Deficit Hyperactivity Disorder: Diagnosis and Management

20


learning disorder

continuous
performance test (CPT)
18

20

(multimodal
management)21

Vitharon Boon-yasidhi

21

22

23
3

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Vol. 57 No. 4 October - December 2012

379

1.
2.
3.
4.
5.

6.

7.

8.
9.
10.

1.

2.
3.
4.
5.
6.
7.
5
8.
9.
10.

23
4

380

24

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Attention Deficit Hyperactivity Disorder: Diagnosis and Management

25

CNS stimulant
(first-line)
dopamine
prefrontal cortex executive
function

80 24

60
26
methylphenidate
2 10 ..
18 .. 36 ..
2
6

Methylphenidate
3-5 2-3
0.3 ../.. 5 .
( ) 25 ..
10 .. (1 ) 25 ..
/

Vitharon Boon-yasidhi

18
0.7-1.0 ../../
60 ../27
6
3-5



2.5 .. (1/4 )
30 ../28
Methylphenidate
12
1

reverse osmosis

18 ../
54 ../ 12
72 ../
Methylphenidate

methylphenidate




29 methylphenidate


30
methylphenidate
monoamine oxidase inhibitor

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31


32
methylphenidate


33
methylphenidate
tic tic
tic
tic 34
tic

tic
Atomoxetine
CNS stimulant
noradrenaline prefrontal cortex
executive function

6
10, 18, 25,
40, 60 ..
CNS stimulant
tic

382

CNS stimulant
tic 0.5 ../../
1-2 1.2 ../../
1.8 ../../

35
atomoxetine
methylphenidate

atomoxetine
monoamine oxidase inhibitor

CYP2D6

2 atomoxetine
2
2
36

2
dopamine noradrenaline
alpha adrenergic
agonist clonidine antidepressant
imipramine buproprion

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Attention Deficit Hyperactivity Disorder: Diagnosis and Management

ADHD rating scale
1

20

Vitharon Boon-yasidhi

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