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Attention  Deficit  Hyperactivity  Disorder  (ADHD)  is  a  state  of  the  brain  that  leads  to  excessive  activity  ,inattention  and  impulsivity  culminating  in  impaired  social  behavior  especially  in  children. It's  a  chronic   disorder  which  if  not  treated  its  symptoms  can  persist  to  adulthood.  Its  prevalence  in  boys  is  almost  four  times  higher  than  in  girls (Wender  , 2000) .

The  symptoms  of  this  condition  can  be  classified  into  three:  predominantly  inattentive  type  ,predominantly  hyperactive-impulsive  type  or  combined  type.  The  symptoms  for  predominantly  inattentive   type  include  the  tendency  to  get  easily  distracted,  the  tendency  to  easily  miss  details,   the  tendency  to  forget  things  easily  and  the  tendency   to  lose  concentration in an  activity (Wender  , 2000).  A  person  with  this  disorder  finds  it  difficult  to  focus  on  one  thing,  gets  bored  with  an  activity  only  after  a   few   minutes  of  doing  it  unless  the  activity  is  interesting   and  doesn't  pay  attention  when  being  spoken  to. 

Other symptoms of predominant inattention include daydreaming, confusion and the tendency to move slowly. The impulsive behavior is manifested as: impatience, act emotionally and without restraint, blurt out comments recklessly as well as acting without regard for the resulting consequences (Wender  , 2000). Predominantly hyperactive-impulsive type symptoms include: restlessness, unrestrained fidgeting, noisiness, tendency to play with nearly everything in sight. Symptoms may persist to adulthood for up to half the victims. Note however that diagnosing ADHD in adults is a clinical procedure. ADHD therefore in adults would be different from say adults due to  adaptive  processes  and  avoidance  habits  learned  during  socialization(Wender  , 2000)  . Diagnosis of  ADHD  becomes  tricky  since  there  are  many  other  cormobidities  whose  symptoms  overlap  those  of  ADHD.  Such  cormobid  disorders  include  but  not  limited  to: conduct  disorder,  antisocial  personality  disorder,  anxiety  disorder,  bipolar  disorder  oppositional  defiant  disorder (ODD), mood  disorders,  personality  borderline  disorder ,  among  others (Wender  , 2000). 

Causes  of  ADHD  are  not  quite  clear  but  environment,  genetic  make-up  and  the  social  setting  where  an  individual  grows  up  are  known  to  be  possible  causes.

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The  environmental  causes  mainly  centre  around  diet. Food  additives  like  artificial  colors ( e.g. Ponceau.4R, Sunset yellow.FCF (E110), quinolline yellow(E104), Tartrazine(E102) and  carmoisine (E122),  as  well as  food  preservatives  like  sodium  benzoate (Wender  , 2000) . A study  conducted  by  researchers  at  Southampton  University  in  the  United  Kingdom  and published  in   'The  Lancet'  on  November  3,  2007  found  an  association  between  intake  of  many  artificial  food  colors  as  well  as  sodium  benzoate-a  preservative,  with  hyperactivity.  Other  than  food  additives, alcohol  and  tobacco  especially  exposure  during  pregnancy,  where  the  nicotine  in tobacco  causes  hypoxia (oxygen  insufficiency)  to  the  foetus,  complications  during  delivery  may  also play  a  role. Sugar  has  also  been  shown  to  play  a role  although  researchers  seem  to  dispute  the  role  played  by  sugar. In  a  research  where  mothers  had  their  children.. given  aspartame  while  others  received  sugar,  those  receiving  sugar  were  reported  as  more  hyperactive  than  those  receiving  aspartame(Neven , 2002) .

Organophosphates especially  those  used  in  insecticides  such  as  chlorpyrifos  which  is  used  on  some  vegetables  and  fruits  have  been  linked  to  delays  in  learning  rates,  reduced  physical  coordination  and  behavioral  problems  in  children  especially  ADHD. A  2010  study  by WHO  found  that  pesticide  exposure  increases  ADHD  risk  in  children.  Researchers  analyzed  organophosphate  residues  in  the  urine  of  over  1,100 children  of  ages  8-15 years  and  found  that  those  with  the  highest  levels  of  dialkyl phosphates  which  are  the  breakdown  which  are  the  breakdown  products  of  organophosphate  pesticides  had  the  highest  incidences  of  ADHD. On average,  the  study  indicated  that  every  10-fold  increase  in  the  pesticide  residues  results  in  35%  probability  of  developing  ADHD (Neven , 2002) .

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Other  than environment,  genes  are  believed  to  exert  some  influence.  ADHD  has  been  shown  to  run  in  families. Researchers  believe   that  a  large  majority  of  ADHD  cases  arise  from  a  combination  of  various  genes  many  of  which  affect  dopamine  transporters.  It has  often  been  shown  that ADHD  does  not  follow  the  traditional  model  of  a  disease. ADHD  should  therefore  be  seen  as  a  complex  interaction  of  among  genetic  and  environmental  factors (Neven , 2002) .

The  other  major  factor  thought  to  cause  ADHD  is  the  social  setting  where  an  individual grows  up. For  instance  children  who  have  suffered  violence  and  emotional  abuse  have  had  behavior  typical  of  ADHD;  Complex  post  traumatic  stress  disorder  can  result  in  attention  problems  which  resemble  ADHD (Neven , 2002) . A report  released  this  year  by  CNN  show  that  there  is  an  increased  risk  for  internationally  adopted  children  to  develop  mental  disorders  such  as  ADHD  and ODD(Oppositional  Defiant  Disorder)  The  risk may  be  related  to  the  time  the  children  spent  in  orphanage  and  more  so  if  the  children  were  neglected (Neven , 2002) .

The average onset of the disorder is between ages 3 to 4 years which coincides with school entry age. The disorder first presents with a pattern of hyperactive-impulsive behavior and in some cases  oppositional and aggressive conduct. The combined type starts between the ages of 5 to 8, while the inattentive type starts between ages 8-12 years. 50-80 percent of clinic-referred children continue with the disorder into adolescence. . The  Inattention  and   hyper-impulsive behavior  however  declines with adolescence. The prevalence of the disorder is relatively low in adulthood (Neven , 2002) .

The  treatment of  this  disorder  combines  behavior  modification, counseling , changes  in  lifestyle  and  medication.  Behavioral  modification  involves  psycho-educational  input ,cognitive  behavioral  therapy ,family  therapy , interpersonal  psychotherapy ,training  and  parent  management  training   and  school  related  interventions.  Parent  training  and  education  have  been  found  to  have  short-term  benefits  and  are  therefore  unreliable (Neven , 2002) . 

Medication is  the  most  cost -effective  method  of  managing  ADHD. This  method  takes  many  forms   with  stimulant  medication  being  a  case  in  point.   Stimulant  medication  is  actually  the  most  preferred  and  prescribed. most  stimulant  medications  include:  methylphenidate , dextroamphetamine ,  dextromethamphetamine , and  lisdexamfetamine . These  stimulants  increase  the extracellular  concentrations  of   neurotransmitters like dopamine  and  norepinephrine  and  this  results  to  a  surge  in  neurotransmission. The dark side of using stimulant medication is 'drug tolerance' to  therapeutic doses. Note that continued exposure to these stimulants results in low production of  the neurotransmitter by the brain as it adapts to the surge, or the brain lowers production of the corresponding receptors (Neven , 2002) . Low  dopamine  levels  can  raise  the  threshold  at  which someone  can maintain  focus  on  a  task  which  is  otherwise  boring.  The  person most likely increases the dosage as they attempt to bring the neurotransmitter level back to normal. Drug tolerance can affect the long term health of the individual affected (Neven , 2002).

Antipsychotic medication involves the use of antipsychotic drugs which block excessive neurotransmission, in some cases blocking dopamine function. The advantage of these drugs is that they  are  less likely  to result  in  movement  disorders, dysphoria  and  increased  drug  cravings. The  adverse  effect  of  this  medication  is  that  it  can  easily  result  in  weight  gain,  diabetes,  fatigue,  sexual  dysfunction  among  others (Neven , 2002) .

Other  non-stimulant  medications include Atomoxetine (strattera)  and Guanfacine. Dietary  supplements  and  specialized  diets  may  reduce  the  symptoms  associated  with  the  disorder.  Omega-3 fatty  acid  rich supplementation (seal  fish  or  krill oil)  may   reduce  symptoms  for  a  subgroup  of  children  and  adolescents  with  the  disorder  characterized  by  inattention  and  neurodevelopmental  problems (Delfos , 2004)  .

Athletics or  any  form  of  aerobic  activity  if  such  is  not  accompanied  with  negative  behaviors  or  stigma  may  increase  peer  acceptance  and  mitigate  complication  of  the  disorder. Art ,  video  games,  cutting  down  on  time  spent  on  television  may  reduce  severity.

Positive  change  in  diet  such as  low  sugar  intake,  low  additives,  no  caffeine  and  outdoor  adventures  in  parks  can  positively  reduce  the  severity  of  ADHD (Delfos , 2004)  .

The  areas  of  the  brain  affected  by  the  disorder  are  not  entirely  clear.  However,  there  is  a  prominent  delay  in  development  of  frontal  cortex  and temporal  lobe of  the  brain  in  most  children.  These  two  structures  are  responsible  for  the  ability  to  control and  focus  thinking  thus  the  thinking  capability becomes  impaired. The motor  cortex  in  the  ADHD  patients  is  found  to  mature  faster  than  normal  which  suggests  that  slower  development  of  motor  cortex  is  essential  for   behavioral  control  in  ADHD  victims (Delfos , 2004)  . There  is  a  marked  reduction  in  brain  volume  for  ADHD  victims  but  mainly  the  prefrontal  cortex.  Studies  suggest  that  a  frontal  lobe dysfunction  can  significantly be  associated  with  the  hyperactivity,  impulsivity  and  inattention  observed  in  ADHD  victims.  Cerebellum  dysfunction  has  also  been  implicated (Delfos , 2004)  .

Blood  circulation  in  these  patients  is  reduced  which  results  in  a  low  neural  activity. There  could  be  significant  thinness  of  the  cortex  of  the  right  side  of  the  brain  where  the  '7-repeat'  variant  of  the  D4 receptor  gene  which  accounts  for  30%  of  the  genetic  risk  of  ADHD  is  involved   though  the  region  normalizes  in  thickness  during  teenage  in  these  children  and  this  coincides   with  clinical  improvement (Delfos , 2004) .

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