Ch apter 2 B eh avioral an d Developm en tal Ped iatrics / 39

t r a in in g, m u lt iple ea r in fect ion s, sen sit ivit y t o sen sor y in pu t , or u n -

u su a l pa in t h r esh olds.
2. As p e rg e r s y n d ro m e
a . Th is s y n d ro m e is a ls o m o re c o m m o n in bo y s .
b. Clin ic a l fe a tu re s
(1) Qu a lita tiv e im p a irm e n t in p e e r re la tio n s h ip s a n d s o c ia l
in te ra c tio n s
(2) Repet it ive, r est r ict ed, a n d st er eot yped pa t t er n s of beh a vior, a c-
t ivit ies, a n d in t er est s
(3) N o c lin ic a lly s ig n ifi c a n t la n g u a g e d e la y. La n gu a ge, in fa ct ,
m a y be a dva n ced.

III. D y s fu n c tio n s o f Atte n tio n (Atte n tio n D e fi c it/Hy p e ra c tiv ity

D is o rd e r, AD HD )

A. D e fi n itio n
1. Ch a ra c te ris tic s o f AD HD in c lu d e p o o r s e le c tiv e a tte n tio n , d iffi -
c u lty fo c u s in g , o r d is tra c tibility. H yper a ct ivit y m a y or m a y n ot be
pr esen t .
2. Ch ildr en wit h disor der s of a t t en t ion m a y sh ow im p u ls iv ity, d is -
tra c tibility, d is in h ibitio n , a n d g e n e ra l be h a v io ra l im m a tu rity.
B . Ep id e m io lo g y a n d e tio lo g y
1. ADH D is m o re c o m m o n in bo y s .
2. Th e c a u s e o f AD HD is u n k n o w n .
a . Ge n e tic fa c to rs p la y a la rg e ro le ; 30–50% of a ffect ed ch ildr en h a ve
a fir st -degr ee r ela t ive wit h ADH D.
b. Abn or m a lit ies in n eu r ot r a n sm it t er fu n ct ion , especia lly dopa m in e a n d
n or epin eph r in e, a lso lea d t o sym pt om s.
C. D iffe re n tia l D ia g n o s is (Ta ble 2-8)
D . Clin ic a l F e a tu re s . Specific cr it er ia m u st be pr esen t , in clu din g:
1. Sym pt om s befor e 7 yea r s of a ge
2. Sym pt om s in m or e t h a n on e en vir on m en t (e.g., sch ool a n d h om e)
3. Im pa ir m en t in fu n ct ion in g in sch ool or in per son a l r ela t ion sh ips
4. Sym pt om s of in a tte n tio n , in clu din g n ot bein g a ble t o focu s du r in g cla ss-
r oom in st r u ct ion , difficu lt y wit h or ga n iza t ion , a n d for get fu ln ess
5. Sym pt om s of h y p e ra c tiv ity, wh ich m a y in clu de fidget in g, a ct in g a s if
dr iven by a m ot or, excessive t a lkin g, a n d difficu lt y r em a in in g sea t ed in
t h e cla ssr oom
6. Sym pt om s of im p u ls iv ity, wh ich m a y in clu de beh a vior su ch a s blu r t in g
ou t a n swer s befor e a qu est ion is com plet ed
E. Effe c t o f a tte n tio n p ro ble m s on t h e ch ild wit h ADH D
1. D iffi c u lty c o n fo rm in g to c la s s ro o m ro u tin e