Antonella Torres Lpez

Fundamentos Biolgicos de la Conducta

Psicologa, Universidad de Navarra

Article: Children with ADHD less likely to suffer injuries with proper

medication

Abstract

Using the article Children with ADHD less likely to suffer injuries with proper

medication published in July 2015, we will discuss attention deficit hyperactivity disorder. It

is a childhood-onset neurodevelopmental disorder characterised by developmentally

inappropriate and impairing inattention, motor hyperactivity, and impulsivity, with

difficulties often continuing into adulthood. It is a common problem affecting boys and girls.

Many risk factors have been associated with ADHD but none have been shown to be causal.

Careful assessment is required to make a diagnosis of ADHD.

Word count: 83

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Introduction

In the article Children with ADHD less likely to suffer injuries with proper

medication published in Lancet Psychiatry, in July 2015 describes a study of 4000 children

diagnosed with ADHD in which the ones who received medication reduced the risk of

injuries by 43% and emergency visits by up to 45% in comparison to those who did not. The

study also revealed that the treatment helped them do better in school. The researchers said

that the findings were important given that accidents are the cause of premature deaths for

those with ADHD. Nevertheless, ADHD treatment medications can present unwanted side

effects which is why its use and prescription should be thoroughly assessed and controlled

(Press & Infosalus, 2015).

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Scientific review of ADHD

Main symptoms

ADHD can be distinguished between inattentive, hyperactive-impulsive, and

combined subtypes. Some people can have problems only with one of the behaviours and

others with both (Thapar, A. & Cooper, M, 2015).

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The inattentive type present symptoms such as: difficulty sustaining attention on tasks and

making careless mistakes, they do not seem to listen when spoken to and are unable to follow

through instructions. Also, they can be forgetful, get easily distracted and not very organized.

On the other hand, those with hyperactivity-impulsivity show symptoms like fidgeting or

tapping hands or feet, they run or climb when its not appropriate and can talk excessively or

interrupt others.

The diagnosis of ADHD requires the presence of symptoms across more than one setting and

that they result in impairment. In the absence of biological tests, the diagnosis is based on

reported symptoms. It includes a detailed history from: the family, observation of the child,

and reports from school or other observers. It is still a difficulty because theres potential risk

of overdiagnosis or underdiagnosis. This is why, when diagnosing a patient, it should be

ensured that any ADHD symptoms are not due to another medical or psychiatric condition

(Thapar, A. & Cooper, M, 2015). Most children with ADHD receive a diagnosis during the

elementary school years. For an adolescent or adult to receive a diagnosis of ADHD

symptoms need to have been present prior to age 12 (The National Institute of Mental Health,

n.d).

Pathophysiology

Even though biological mechanisms through which genetic and environmental factors

interact to alter neurodevelopment in ADHD are not yet understood, there remains no

diagnostic neurobiological marker. Findings in animals have suggested dopaminergic,

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noradrenergic and serotonergic neurotransmission. In addition, fMRI studies have shown

alterations in several networks including those related to attention and executive function.

Regarding brain structure they showed alterations in the basal ganglia and limbic areas

(Thapar, A. & Cooper, M, 2015).

Epidemiology

Estimated prevalence of ADHD in children is 3.4% (95% CI 2.6 - 4.5), it does not

vary by geographical location but is affected by different assessment methods and diagnostic

conventions. Late 20th and early 21st centuries show no evidence of a rise in rates of

symptoms or diagnosis over time. However, there has been a marked rise in the number of

prescriptions issued for pharmacological treatment across high income countries in the past

decade. There is no evidence of rising population rates explained by social change, contrary

to the opinion of some people. Also, a strong epidemiological finding is the excess of

affected male individuals which suggests bias in relation to female patients with ADHD

(Thapar, A. & Cooper, M, 2015).

Treatment and future research and clinical directions

If pharmacological treatment is prescribed, it should be in combination with

behavioural interventions. However, there is no one size fits all solution to management.

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Stimulants such as methylphenidate and dexamfetamine are the first-line pharmacological

treatments and the noradrenaline reuptake inhibitor atomoxetine is the second line treatment.

Both increase catecholamine availability (Thapar, A. & Cooper, M, 2015).

Word count: 350

Critical Analysis

The article chosen is very relevant to the subject because being ADHD a

neurodevelopmental disorder with high prevalence associated with structural, functional,

electrical and chemical activity it covers many areas of importance to a psychologist in order

to be able to diagnose and treat a patient dealing with the related symptoms. Specifically, it

shows clear relation to topics studied such as how theres a delayed cortical development,

abnormalities in connecting brain cells within networks that regulate attention and emotion,

delayed maturation of certain dopaminergic neural pathways as well as an imbalance in the

levels of both dopamine and noradrenaline. There is also a genetic background which can

relate further down the course as well as to psicologa de la atencin y la percepcin where

we can understand how attention works as well as the models of attention currently being

used.

Its also an opportunity to see how the nervous system can differ from patient to patient

which is why each individual should be treated as a unique biopsychosocial being. What I

found really interesting is the emphasis given in The Lancet article to the aspect of

diagnosis which is something to take extreme care of before putting a patient a label. As there

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is not a best way of defining the disorder and theres is not an exact biological test there is

a greater chance of misdiagnosis and inappropriate pharmacological interventions which is

why a person should be viewed dimensionally.

Certainly, treatments have contributed to improvement in the life of the subjects either by

reducing accidents and improving performance at school and at home. Finally, an issue of

personal concern that has taken more awareness is how ADHD symptoms can vary from

males to females and, due to this, many can go undiagnosed. Its not taken seriously enough

until the individual has already begun to fail across multiple domains. This is why I think

there is a huge responsibility to inform parents, teachers and clinicians that girls cannot be

judged the same way as boys because their neurodevelopment is different as well as their

behaviour. The earlier it can be detected the better, as for when the child grows, the different

transitions in life are made more manageable.

Word count: 372

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Bibliography

Press, E., & Infosalus. (july 13, 2015). Menos cadas y lesiones en nios con
TDAH en tratamiento. Retrieved october 7, 2016, from Infosalus,
http://www.infosalus.com/asistencia/noticia-menos-caidas-lesiones-ninos-tdah-t
ratamiento-20150731131327.html

The National Institute of Mental Health. (No date). Attention Deficit

Hyperactivity Disorder. Retrieved october 6, 2016, from The National Institute
of Mental Health,
https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-
adhd/index.shtml#part_145449

Thapar, A. & Cooper, M. (september 17, 2015). Attention deficit hyperactivity

disorder. Retrieved october 6, 2016, from The Lancet,
http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(15)00238-X