Hyperactivity defined

The most useful diagnostic criteria for ADHD is the Diagnostic and Statistical Manual of Mental Health Disorders, 4th edition, Text Revision (DSM-IV-TR) (Table 39-1). The DSM-IV-TR defines three subtypes of ADHD (1) predominately inattentive, (2) predominantly hyperactive/impulsive, and (3) combined, in which both inattentive and hyperactive symptoms are evident.11... 

The first indication that modification of specific tail residues were linked to chromatin functional states, came from immunostaining of Drosophila polytene chromosomes with antibodies specific for H4 acetylated at defined lysines [13]. As shown in Fig. 2A, H4 acetylated at lysine 16 (H4acK16) was found almost exclusively on the transcriptional hyperactive male X chromosome (Fig. 2). (Genes on the Drosophila male X are transcribed twice as fast as their female counterparts so as to equalize levels of X-linked gene products between XY males and XX females.) In addition, H4 lysine 12 was found to remain acetylated in centric heterochromatin, while lysines 5, 8, and 16 were all under-acetylated [13]. These observations led to the suggestion that the histone N-terminal tails constitute nucleosome surface markers that can be recognized by non-histone proteins in a modification-dependent manner to alter the functional state of chromatin [13]. 

Younger children with manic symptoms tend to have severe functional impairment and comorbid psychopathology such as anxiety dysregulation, disruptive behaviors, and developmental delays that further complicate their clinical picture. In addition, these children may have mood symptoms that merge with other disorders, making manic episodes difficult to define. Irritability is part of the clinical picture of depression, anxiety, attention-deficit hyperactivity disorder (ADHD), and oppositional defiant disorder (ODD). Poor concen-... 

FIGURE 53.1 Cumulative distribution curves of final ADHD scores by treatment group in the MTA Study. The SNAP rating is average score of the 18 items corresponding to the DSMTV defining symptoms for attention-deficit-hyperactivity disorder and oppositional defiant disorder (range 0, not present to 3 very much). Beh, Behavior... 

In both disorders the described behaviors are very similar, but the ICD-10 defines a more severe disorder with a guarded prognosis (1) all three core problems of attention, hyperactivity, and impulsiveness should be present (whereas the DSM-IV defines three subtypes predominantly inattentive type, hyperactive impulsive type, and combined type) (2) pervasiveness throughout different situations is determined by more stringent criteria and (3) the presence of another mental or behavioral disorder is an exclusion criterion. 

Shaywitz BE, Fletcher JM, Shaywitz SE. Defining and classifying learning disabilities and attention-deficit/hyperactivity disorder. J Child Neuro, 1995 10 S50-S57... 

By 1970, only about 150,000 children were taking Ritalin. During the 1970s, the central problem of the condition was redefined as one of poor attention and distractibility with no mention of hyperactivity. In 1980, psychiatrists official guidelines on defining the condition were revised, and attention-deficit/hyperactivity disorder (ADHD), was added as a new disease. Millions of children who were not hyperactive fit the description of this new disease and could be prescribed Ritalin for their symptoms. Not surprisingly, the number of elementary school children taking Ritalin increased, from 270,000 to 541,000 in 1980 to 750,000 in 1987.3... 

The symptoms of inattention, distractibility, and/or hyperactivity that define attention-deficit/hyperactivity disorder (ADHD) improve when treated with the stimulant drug Ritalin. For long-term success, however, the behaviors associated with these symptoms can also addressed with different techniques, some of which have been described in Chapter 2. 

Hyperactivity-impulsivity is defined as at least four of the following symptoms persisting to a significant degree for at least six months ... 

Although the etiology of autism is not understood, the defining or core symptoms of autistic disorder are considered to be impaired social interaction, impaired verbal and nonverbal communication, and restrictive, repetitive patterns of behavior. In addition, most patients with a primary diagnosis of autism exhibit other neurological or psychiatric symptoms, which may include seizures, sleep disorders, anxiety, panic attacks, attention deficit/hyperactivity, self-injury, and cognitive impairment (Simonoff et ah, 2008). It is not known to what extent these comorbidities reflect the primary pathology of autism and to what extent they represent unrelated vulnerabilities that are exacerbated by the impaired social interaction and communication that is characteristic of the disorder. 

Controlled studies of hyperactivity in children on defined diets produce inconsistent results. 

Defined diets should not be used universally for treating childhood hyperactivity. 

Consensus Conference Defined diets and childhood hyperactivity. JAMA 248 290-292, 1982... 

A word about prevalence mental illness is more common than many people imagine. The current prevalence estimates are that about half the U.S. population meets the criteria for at least one mental disorder during a lifetime, with about 25 percent of the population meeting the criteria for at least one mental disorder during any given year.1 Of these disorders, the most prevalent are apparently anxiety disorders, followed by mood disorders (for example, major depressive disorder), impulse-control disorders (for example, attention deficit hyperactivity disorder [ADHD]), and substance disorders (for example, alcohol abuse). In contrast, the prevalence of psychosis as I define it here is only 2—3 percent of the U.S. population, and the world prevalence is about the same. 

In the last decades, attention deficit and hyperactivity disorders syndrome (ADHD) has been defined as a developmental disorder involving difficulties with sustained attention, distraction, poor impulse control and hyperactivity or inabihty to regulate activity level to situational demands. The disorder is befieved to occur early in childhood and is considered organic in pathology (Table 68.1). The current cfinical view is that the hyperactive—impulsive symptoms tend to emerge first in development, with those... 

National Institute of Health Consensus Development Conference Statement Defined Diets and Childhood Hyperactivity, 1983, Am. J.Clin. Nutr. 37 161. 

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