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What is ADHD?

Some Pathophysiology

The neurotransmitters dopamine (DA) and norepinephrine (NE) are implicated in the pathophysiology of ADHD. Dopamine is a neurotransmitter involved in reward, risk taking, impulsivity, and mood. Norepinephrine modulates attention, arousal and mood. Brain studies on individuals with ADHD suggest a defect in the dopamine receptor D4 (DRD4) receptor gene and overexpression of dopamine transporter-1 (DAT1). The DRD4 receptor uses DA and NE to modulate attention to and responses to one's environment. The DAT1 or dopamine transporter protein takes DA/NE into the presynaptic nerve terminal so it may not have sufficient interaction with the postsynaptic receptor. The implications of these limited receptor findings require further study, however, it seems clear that dopamine and norepinephrine are involved in the pathophysiology of ADHD. Although not a primary cause, family environment adversity factors (eg. high degree of psychosocial stress, maternal mental disorder, paternal criminality, low socioeconomic status, foster care) have been linked to increased rates of ADHD as well.[18] Dietary causes are unlikely, although an overall healthy diet which includes whole grains, 5 or more servings of fruits and/or vegetables, and protein with minimal processed sugars, as recommended by the American Dietetic Association, can eliminate diet as a contributing factor.

ADHD-DSM Diagnosis

According to the DSM IV-TR Attention-Deficit/Hyperactive Disorder are diagnosed based on the following criteria: Either (1) or (2): 1: six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with the development level: A-often fails to give close attention to details or makes careless mistakes in school work, work, or other activities. B-Often has difficulty sustaining attention to tasks or play activities. C-Often does not seem to listen to when spoken to directly. D-Does not follow through with instructions and fails to finish work E-often has difficulty organizing tasks and activities. F-often avoids, dislikes, or is reluctant to engage In tasks that require mental effort. G-Often loses things necessary for tasks or activities I-often forgetful of daily activities

ADHD continued

2:Six (or more) following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with development level:

A-often fidget with hands or feet and squirms in seat B-often leaves seat in classroom or in other situations in which remaining seated is expected C-Often runs about or climbs excessively in situations in which it is inappropriate, may be limited to subjective feelings of restlessness. D-often had difficulty playing or engaging in leisure activities quietly. E-Often on the go, or acts as if driven by a motor F-often talks excessively G-often blurts out answers before question has been asked H-often has difficulty awaiting turn I-often interrupts or intrudes others on conversations, etc.

ADHD is More than Just 1 issue

ADHD on the Rise

According to the CDC

Approximately 11% of children 4-17 years of age (6.4 million) have been diagnosed with ADHD as of 2011. The percentage of children with an ADHD diagnosis continues to increase, from 7.8% in 2003 to 9.5% in 2007 and to 11.0% in 2011. Rates of ADHD diagnosis increased an average of 3% per year from 1997 to 2006 [Read article] and an average of approximately 5% per year from 2003 to 2011. Boys (13.2%) were more likely than girls (5.6%) to have ever been diagnosed with ADHD. The average age of ADHD diagnosis was 7 years of age, but children reported by their parents as having more severe ADHD were diagnosed earlier. Prevalence of ADHD diagnosis varied substantially by state, from a low of 5.6% in Nevada to a high of 18.7% in Kentucky.

Research Article iewer/pdfviewer?sid=d4adefb8-26294476-904b7a11d03ce127%40sessionmgr4005&vid =6&hid=4207

Legal, Moral, Ethical Implications of Care

Legal: From an attorneys perspective, representing a juvenile with ADHD can be challenging. Because of the symptoms of distractibility, inattentiveness, and immaturity, ADHD may significantly interfere with an attorneys ability to obtain reliable and precise information from the ADHD child, including information about the alleged crime. In addition, a juveniles ability to provide information within an appropriate time perspective (i.e., when an incident occurred or how long an incident lasted) is likely to be impaired due to the difficulties encountered by this disorder. This may be particularly frustrating when attempting to reconcile conflicts in a juveniles self-report and witness statements. Interestingly, the same problems may arise in cases in which a witness or an alleged victim suffers from ADHD, thereby potentially affecting the precision and/or reliability of the witness statements, depositions, and trial testimony. More specifically my pt came into Queens on a MH4 involuntary 48hour hold. She is to be transitioned into the residential program according to the MDs order.

Moral or Immoral?
Are children being overmedicated? Is normal childhood behavior being medicalized? What is the long-term safety of psychotropic drugs? How effective and safe is it to use those drugs that have only been tested in adults?

What is ethical?
Parents are being told my physicians that medication is the best route to go for treatment. Why is it that doctors automatically suggest medicating the child? Some say, the behavioral therapy is better?

According to data collected, girls are more likely to suffer from other learning disabilities in addition to suffering from ADHD or some other form of learning disability. Boys are not ruled out, but the data shows that girls are predisposed more significantly than boys. ADHD is a very real illness that many children and young adolescents suffer with and it can be a very distracting and difficult disease to suppress.