Disease Description (Causes and Symptoms)
- Definition: Attention-Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that mainly manifests during childhood and is characterized by a combination of persistent inattention, hyperactivity, and impulsivity. If not appropriately treated, it may cause long-term difficulties in academic performance, interpersonal relationships, and behavior, and symptoms may persist into adulthood in some cases (30–70%).
- Main causes and pathophysiology:
- Imbalances in neurotransmitters related to attention and concentration, such as dopamine and norepinephrine.
- Structural and functional differences in brain regions involved in attention and behavior regulation, such as the frontal lobe.
- In some cases, environmental factors such as brain injury, a history of prematurity, and prenatal alcohol exposure.
- Main symptoms:
- Inattention: easily distracted, difficulty following instructions, difficulty completing tasks, losing belongings, frequent mistakes, and so on.
- Hyperactivity and impulsivity: inability to remain still, fidgeting with the hands and feet, excessive talking, answering before a question is finished, difficulty waiting one's turn, and so on.
- Prevalence and characteristics: The worldwide prevalence among school-age children is approximately 3–8%. It is reported to be approximately 4–6 times higher in boys than in girls, and studies in some countries have reported that approximately 5% of elementary school students show symptoms.
Treatment Methods
- General principles: The standard is to combine medication and nonpharmacological treatment (education and creation of a therapeutic environment). Treatment is tailored according to individual symptoms, comorbidities, and age.
- Medication (standard treatment):
- Central nervous system stimulants: methylphenidate (immediate-release and extended-release), amphetamine-based medications (extended-release formulations) — first-line medications that improve symptoms in many patients (approximately 70–80%).
- Nonstimulants: atomoxetine, guanfacine (guanfacine ER), clonidine, and others — used when patients do not respond to stimulants or experience adverse effects.
- Treatment duration: In many cases, follow-up and adjustment are needed for at least several months to 1.5–2 years or longer. Evaluation and decisions about discontinuation should be made stepwise according to the doctor's instructions.
- Main adverse effects: decreased appetite (monitor weight and growth), insomnia, headache, abdominal pain, mood changes, and, rarely, worsening of tics or cardiovascular effects (changes in heart rate and blood pressure).
- Safety: Long-term medication use is reported to be relatively safe under appropriate medical supervision, and the risks of addiction and tolerance are low when properly managed.
- Nonpharmacological treatment:
- Parent education and home-environment management (consistent rules, rewards, and positive reinforcement).
- Behavioral therapy and cognitive behavioral therapy (CBT): management of impulsivity and improvement of self-regulation skills.
- Learning therapy and school-based interventions: dividing assignments into smaller parts, setting homework times, adjusting the testing environment, and so on.
- Play therapy, social-skills training, and group therapy supporting peer relationships.
- Monitoring during treatment:
- Regularly check weight and height; changes in blood pressure and heart rate; changes in sleep and appetite; mood, self-harm, and suicidal thoughts; and the presence of tics or abnormal movements.
- If necessary, perform electrocardiography (when underlying heart disease is suspected) and evaluate psychiatric comorbidities.
Outpatient Visit Checklist (Including Preparation Items and Example Questions)
- Recommended items to bring:
- A list of currently used medications (including conventional medicines and herbal medicines), along with dosages and administration times.
- School or teacher observation records (problems during class, changes in grades, and so on) and a behavior observation diary (frequency and situations in which symptoms occur).
- Previous diagnoses and test results (cognitive tests, attention tests, physical examinations, electrocardiography, and so on).
- Growth records (weight and height data are useful if available).
- Family history (psychiatric disorders, heart disease, tic disorders, and so on).
- Information that is helpful to share with the doctor during the outpatient visit:
- When symptoms began and in which situations they become more severe (at home, at school, during play, and so on).
- Changes before and after taking medication (concentration, sleep, appetite, and mood).
- The areas that cause the most difficulty in daily life (learning, interpersonal relationships, behavior control, and so on).
- Items the doctor may ask about during the visit:
- Age at symptom onset and duration, reports from home and school, previous treatment experiences, and accompanying symptoms (depression, anxiety, tics, sleep disorders, and so on).
Examples of General Questions to Ask the Doctor
- "What are the main adverse effects of this medication (or treatment), and how will they be monitored?"
- "What are the treatment goals, and how soon can we expect to see effects?"
- "What effects could this have on my child's growth (weight and height) or heart health?"
- "When can the medication be discontinued? What should be checked when it is discontinued?"
Examples of Condition-Specific Questions
- For parents of children and adolescents: "Is a stimulant or a nonstimulant more suitable for my child? What is the basis for this choice?"
- For coordination with the school: "How should we request specific educational and environmental adjustments that can be implemented at school (such as dividing homework into smaller parts and adjusting the testing environment)?"
Additional information: Because comorbidities (learning disabilities, anxiety or depression, tic disorders, sleep problems, and so on) are common, it is recommended that they also be assessed during the evaluation. The treatment plan should be adjusted through regular reassessment according to symptoms, adverse effects, and the developmental stage.