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Hiperkinetism

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#1
betz

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Ne poate spune cineva cate ceva despre acesti copii? ce sanse au, care este tratamentul, cum trebuie crescuti. Mentionez ca acesti copii sunt cei cu deficit de atentie, concentrare, etc

#2
mianna

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parerea mea e ca de cele mai multe ori e dificil de trasat granita intre un copil dinamic si unul hiperkinetic. si ca, din cate stiu, in state e o tedinta de a indopa cu pastilute orice copil care-i un pic mai activ decat un bibelou. cam riscant. habar n-am cum e la noi, dar sper sa nu ajungem prea curand la asta.

in rest las vreun psihiatru, daca este printre noi, sa ne povesteasca ce se intelege prin hiperkinetism.

#3
vali matei

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View Postmianna, on Apr 24 2007, 17:34, said:

parerea mea e ca de cele mai multe ori e dificil de trasat granita intre un copil dinamic si unul hiperkinetic. si ca, din cate stiu, in state e o tedinta de a indopa cu pastilute orice copil care-i un pic mai activ decat un bibelou. cam riscant. habar n-am cum e la noi, dar sper sa nu ajungem prea curand la asta.

in rest las vreun psihiatru, daca este printre noi, sa ne povesteasca ce se intelege prin hiperkinetism.

Eu sunt psihiatru, dar nu de copii ci de adulti. Am sa incerc  mai jos sa fac o sinteza o sinteza (sursa Comprehensive textbook of psychiatry eds Kaplan and Sadock) despre adhd. Da Mianna poate exista intr-adevar risc de "zel" diagnostic si terapeutic, desi utilizarea criteriilor acceptate de diagnostic incearca sa impiedice asta (se specifica clar ca tulburarea respectiva trebuie sa fie clinic semnificativa, sa aiba o anumita durata minima si sa fie asociata cu afectarea functionarii sociale, profesionale etc a omului respectiv).
ATTENTION-DEFICIT/HYPERACTIVITY DISORDER
Attention-deficit/hyperactivity disorder (ADHD) is the most common psychiatric disorder among school-age children and the best understood. Children with ADHD display the early onset of symptoms consisting of developmentally inappropriate overactivity, inattention, academic underachievement, and impulsive behavior. The need for treatment of ADHD is highlighted by the increased risk of ADHD children for delinquency, accidents, and substance abuse. Although the disruptive behaviors of ADHD are usually the reason for referral for treatment, ADHD in childhood and adolescence is often associated with other psychopathology. Considerable knowledge supports the premise that ADHD is a familial disorder associated with differences in central nervous system structure, metabolism, and processing. Treatment of patients with ADHD involves multiple interventions and should be guided by a complete assessment of current functioning in multiple domains of school, family, and peer relationships and comorbid symptoms.
Epidemiology
In general, a variety of epidemiological data consistently find ADHD to be a common disorder in community samples of children and adolescents (on average identified in 3 to 5 percent) and one of the most common disorders among children referred to child mental health services.
Etiology
Considerable progress has been made toward revealing the pathophysiological basis of ADHD. Studies of ADHD neurochemistry, neuroimaging, epidemiological risk factors, and genetics have supported the notion that ADHD is a familial disorder involving differences in monoamine regulation and frontal-striatal neural circuitry. Additional studies should soon add detail to early findings and improve early detection of risk and intervention.  The incontrovertible benefit of psychostimulants on hyperactive and impulsive behaviors has resulted in research into neurochemical differences in children with ADHD, principally among the monoamines dopamine and norepinephrine.
Genetics
Compelling evidence supports the view that ADHD is familial and in large part genetic. In spite of differences in diagnostic criteria, most published controlled family studies report a significantly higher relative risk of ADHD in first-degree and second-degree relatives of probands with ADHD than in normal controls.
Other etiological influences
Several studies have reported associations between ADHD, pregnancy, and delivery complications. Some but not all reports have noted exposure to maternal toxemia in children later diagnosed with ADHD. Other studies suggest that problems during labor, fetal distress, and other birth complications are associated with later disruptive behavior problems. Such experiences may be particularly germane to the etiology of ADHD in children who lack a family history of the disorder. Similarly, these adverse neonatal events may be associated with particular forms or subgroups of ADHD such as ADHD with comorbid conduct disorder.
Diagnosis and Clinical Features
A. 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 developmental level:
Inattention
(a) often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
( b ) often has difficulty sustaining attention in tasks or play activities
( c ) often does not seem to listen when spoken to directly
(d) often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
(e) often has difficulty organizing tasks and activities
(f) often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
(g) often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
(h) is often easily distracted by extraneous stimuli
(i) is often forgetful in daily activities
(2) six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:
Hyperactivity
(a) often fidgets with hands or feet or 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 (in adolescents or adults, may be linked to subjective feelings of restlessness)
(d) often has difficulty playing or engaging in leisure activities quietly
(e) is often "on the go" or often acts as if "driven by a motor"
(f) often talks excessively
Impulsivity
(g) often blurts out answers before questions have been completed
(h) often has difficulty awaiting turn
(i) often interrupts or intrudes on others (e.g., butts into conversations or games)
B. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.
C. Some impairment from the symptoms is present in two or more settings (e.g., at school [or work] and at home).
D. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.
E. The symptoms do not occur exclusively during the course of a pervasive developmental disorder, schizophrenia, or other psychotic disorder and are not better accounted for by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, or a personality disorder).

Comorbidity
Studies of epidemiological and clinical samples of children with ADHD find a high frequency of other overlapping symptoms and diagnoseable disorders, including significant rates of both mood and anxiety disorders as well as other disruptive behavior disorders. Recognition of these associated conditions carries important implications for assessment, prognosis, treatment approaches, and research. For example, the association of ADHD and conduct disorder is reportedly related to later development of substance abuse. While continued debate exists over whether these apparent comorbidities are due to artifactual comorbidity produced by current criteria, other research finds cause for comorbidity in shared deficits and other possible mechanisms of association. In general, the high frequency of associated psychopathology has been argued to reflect the heterogeneity of ADHD itself.
Course and Prognosis
Although complicated by differing diagnostic criteria, sample characteristics, and methodology, studies have yielded much about the course of ADHD. These findings include reports from a variety of well-controlled prospective follow-up studies with follow-up as long as 15 to 17 years after initial assessment. In general, both longitudinal studies and descriptions of older samples of individuals with ADHD consistently reveal changes in the core symptoms of ADHD with the development and the appearance of new problem behaviors. The most striking observation is the strong persistence of the diagnosis over time, supporting the prognostic validity of the diagnosis. Recognition of the variety of adverse outcomes of individuals with ADHD shows the need for aggressive, multimodal intervention approaches.
Treatment
Practice parameter guidelines for the assessment and treatment of ADHD have been published by the American Academy of Child and Adolescent Psychiatry. While a wide variety of treatments have short-term efficacy for some symptoms of ADHD, few demonstrations of long-term efficacy of comprehensive and clinically relevant treatment programs exist. Treatments with strong empirical validation of efficacy include medications (particularly the psychostimulants) and certain psychosocial therapies.
The short-term benefits of medication treatment of ADHD has been confirmed in well over 100 studies that included thousands of children with ADHD. The short-acting psychostimulants remain the first-line choice for the pharmacotherapy of ADHD, principally because of their ability to improve both behavioral and cognitive aspects of the disorder in 70 to 80 percent of children. The safety profile for the stimulants is also excellent. However, interest continues in identifying alternatives to stimulants, for such reasons as the significant comorbidity of ADHD with other disorders, occasional intolerance of stimulant adverse effects, the inconvenience of multiple dosing, and infrequent lack of efficacy.
The behavioral and cognitive effects of stimulants on ADHD are robust and extensive.
Also in use norepinephrine reuptake inhibitors and so on.
Sper sa ajute. Am zis sa postez toata povestea asta lunga (desi lunga e ...sinteza) ca ma gandesc ca poate ajuta pe cineva. Oricum, ca in orice alta situatie, experienta clinica e necesara, asa ca in acest caz consultati, inainte de a va ingrijora, un psihiatru de copii.

Edited by mianna, 24 April 2007 - 19:42.


#4
mianna

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nu zic ca nu-i folositoare (pentru cine are rabdarea s-o citeasca si cunostintele minime s-o inteleaga :) ), dar in cuvintele tale, ce ne poti spune despre ea? cum se jongleaza la noi cu diagnosticul asta?

mi se par extrem de laxe criteriile. mai ales acel "often". daca-mi pun mintea, il diagnostichez pe copilul celei mai bune prietene cu ADHD, dar mi s-ar rupe inima sa-l stiu pe medicatie. eu zic ca-i pur si simplu un copil istet si activ, cu usoare inclinatii de lider :)

#5
depressed_daysleeper

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O intamplare reala (acum amuzanta) mi s-a intamplat si mie..tocmai de aceea am cautat pe net despre sindromul ADHD.
Cand am schimbat medicul de familie acum ceva ani, uitandu-ma intamplator pe fisa cu toata evidenta mea medicala am zarit trecut "Hyperkinetism"..ia uite domne'aveam si nici nu stiau ai mei, sau cum? Bineinteles, n-am avut si n-am dat vreodata semne de asa ceva.
Ceea ce am scris nu ajuta prea mult pe cei direct interesati de sindromul hyperactivitatii, insa ridica semne de intrebare (cel putin mie) referitoare la usurinta unor medici de a pune un diagnostic (?!)..sau probabil a trecut asa, la intamplare, eu nici in ziua de azi nu am aflat.
Betz, multa bafta, si sper sa aflii cat mai multe dar mai ales sa-ti fie de folos..:)

#6
mianna

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View Postdepressed_daysleeper, on Apr 24 2007, 21:28, said:

O intamplare reala (acum amuzanta) mi s-a intamplat si mie..tocmai de aceea am cautat pe net despre sindromul ADHD.
Cand am schimbat medicul de familie acum ceva ani, uitandu-ma intamplator pe fisa cu toata evidenta mea medicala am zarit trecut "Hyperkinetism"..ia uite domne'aveam si nici nu stiau ai mei, sau cum? Bineinteles, n-am avut si n-am dat vreodata semne de asa ceva.
Ceea ce am scris nu ajuta prea mult pe cei direct interesati de sindromul hyperactivitatii, insa ridica semne de intrebare (cel putin mie) referitoare la usurinta unor medici de a pune un diagnostic (?!)..sau probabil a trecut asa, la intamplare, eu nici in ziua de azi nu am aflat.
Betz, multa bafta, si sper sa aflii cat mai multe dar mai ales sa-ti fie de folos.. :)

zi mersi ca nu te-or dopat :) sau ... nu de la pastile ti se trage nick-ul? :D

#7
vali matei

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View Postmianna, on Apr 24 2007, 20:41, said:

nu zic ca nu-i folositoare (pentru cine are rabdarea s-o citeasca si cunostintele minime s-o inteleaga :) ), dar in cuvintele tale, ce ne poti spune despre ea? cum se jongleaza la noi cu diagnosticul asta?

mi se par extrem de laxe criteriile. mai ales acel "often". daca-mi pun mintea, il diagnostichez pe copilul celei mai bune prietene cu ADHD, dar mi s-ar rupe inima sa-l stiu pe medicatie. eu zic ca-i pur si simplu un copil istet si activ, cu usoare inclinatii de lider :)

Pai si de aia ziceam ca e vorba de judecata clinica (gan acel often). Dar severitatea simptomelor citate si frecventa lor sunt foarte importante. Se poate gresi, evident (de exemplu un parinte are un copil foarte energetic si... sanatos, dar acel parinte crede ca acest comportament este excesiv, se duce cu copilul la medic si ii povesteste de asa natura incat sa "iasa" copilul bolnav (exemplul tau de mai sus e foarte bun, este extrem de probabil ca acel copil sa fie cum spui tu). Evident ca nu vreau sa para ca dau vina pe parinti, dar si o ingrijorare excesiva (ca si indiferenta!) e periculoasa. De aici cred ca pot fi multe surse de erori, dar cu siguranta mai pot fi si multe altele, ca in toata practica medicala (sa pui prea repede un diagnostic. Asta e aproape o cutuma in tara noastra, sa iesi din "prima" cu o reteta de la medic. Pentru unele diagnostice ai nevoie de mai mult timp si investigatii).

#8
mianna

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View Postvali matei, on Apr 24 2007, 20:31, said:

Diagnosis and Clinical Features
A. 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 developmental level:
Inattention
(a) often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities - da; cum ziceam insa, "often"-ul ala-i relativ.
( b ) often has difficulty sustaining attention in tasks or play activities - se plictiseste destul de repede, nu-l poti tine o zi intreaga linistit c-o carte de colorat.
( c ) often does not seem to listen when spoken to directly - nu.
(d) often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions) - da, neatentia (si eu am suferit de ea :) )
(e) often has difficulty organizing tasks and activities - greu de evaluat la 8 anisori.
(f) often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework) - adica daca prefera joaca? :D fireste.
(g) often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools) - da, e imprastiat.
(h) is often easily distracted by extraneous stimuli - care copil nu e? si multi dintre adulti.
(i) is often forgetful in daily activities - asta n-o inteleg - ce sa uite? sa se spele pe dinti? nu.
(2) six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:
Hyperactivity
(a) often fidgets with hands or feet or squirms in seat - nu.
( b ) often leaves seat in classroom or in other situations in which remaining seated is expected - da, dar parerea mea e ca e din cauza ca i se permite asta.
( c ) often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be linked to subjective feelings of restlessness) - cam greu de evaluat la 8 ani.
(d) often has difficulty playing or engaging in leisure activities quietly - da, nu-i genul de copil-papusa despre care n-ai habar ca-i in aceeasi incapere cu tine.
(e) is often "on the go" or often acts as if "driven by a motor" - da, copil dinamic, energic.
(f) often talks excessively - nu stiu, e destul de vorbaret (pentru mine asta-i o calitate), n-as zice insa ca e "excessively". dar e un criteriu subiectiv - daca mama ar avea chef sa se uite la un "iarta-ma", sau tatal sa asculte stirile sportive, si n-ar putea de gurita lui, cred ca-i lesne de calificat drept "excesiv".
Impulsivity
(g) often blurts out answers before questions have been completed - da.
(h) often has difficulty awaiting turn - da, ii place sa fie in centrul atentiei.
(i) often interrupts or intrudes on others (e.g., butts into conversations or games) - da, cam asta intelegeam prin "calitati de lider". ideea e ca n-o face la modul deranjant.
B. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.
C. Some impairment from the symptoms is present in two or more settings (e.g., at school [or work] and at home).
D. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.
E. The symptoms do not occur exclusively during the course of a pervasive developmental disorder, schizophrenia, or other psychotic disorder and are not better accounted for by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, or a personality disorder).

cum se vede, intruneste destule criterii. din fericire, nu pana la nivelul de a fi considerat maladaptive and inconsistent with developmental level. dar daca si-ar pune mintea careva...

#9
depressed_daysleeper

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View Postmianna, on Apr 24 2007, 21:50, said:

zi mersi ca nu te-or dopat :) sau ... nu de la pastile ti se trage nick-ul? :D

nu..nick-ul vine de la prea multa socializare zilnica si intr-adevar fortata :)..in rest, am scapat ieftin..pai daca citea dreacu' alt medic ce-a scris aia acolo chiar se punea pe ganduri. ca si mine de altfel.

#10
betz

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Da, probabil ca in diagnosticarea unui copil cu acest sindrom se pot face erori insa era vorba de copii intr-adevar bolnavi , de cei intr-adevar afectati de acest sindrom. Este vorba de copii cu deficit mare de atentie , copii care nu se pot concentra, copii care nu pot purta un dialog pentru ca in capul lor ideile se succed cu mare repeziciune si in afara de un raspuns scurt la intrebarea ta nu pot mai mult.... La acesti copii ma referea si nu la cei activi dar perfect normali :-).

#11
vali matei

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View Postbetz, on Apr 25 2007, 09:43, said:

Da, probabil ca in diagnosticarea unui copil cu acest sindrom se pot face erori insa era vorba de copii intr-adevar bolnavi , de cei intr-adevar afectati de acest sindrom. Este vorba de copii cu deficit mare de atentie , copii care nu se pot concentra, copii care nu pot purta un dialog pentru ca in capul lor ideile se succed cu mare repeziciune si in afara de un raspuns scurt la intrebarea ta nu pot mai mult.... La acesti copii ma referea si nu la cei activi dar perfect normali :-).

Niste adrese utile:
talkingADHD.com

ADHDsupport.com

myADHD.com

Advances in ADHD.com

medscape

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