Comorbidities in ten children with Attention deficit hyperactivity disorder ADHD)

Aims: Attention Deficit and Hyperactivity Disorder – ADHD is one of the most common neuro-developmental disorders (cognitive and behavioural) in childhood and adolescence, and it is characterised by symptoms of hyperactivity, impulsiveness and detention disturbance. A diagnosis is made on the basis of the appropriate diagnostic criteria (Diagnostic and Statistical manual - DSM-IV) and the International Classification of Disorders – ICD-10. The aim of this study was to present the accompanying difficulties (comorbidities) in children with ADHD. Methods: Ten children were included in the study aged from 5 to 16 years. A detailed pre-, peri- and post-natal history was recorded. In order to confirm or exclude disorders related to ADHD a neuropaediatric examination was undertaken, a psychiatric and psychological evaluation was performed and laboratory tests and EEG recordings were undertaken (including sleep EEG). In most children neuroradiological diagnostics were also performed such as CT (computerized tomography) of the brain and MR (nuclear magnetic resonance) of the brain. Results: Eight children had normal EEG findings. Apart from certain EEG abnormalities characteristic for the appropriate types of epilepsy, the patients mostly recorded slow dysrhythmic activity of high amplitude on the EEG recording. Eight children had pathological results of neuroradiological brain examinations: focal cortical dysplasia, multiple cavernous hemangiomas, post-traumatic glial scars, periventricular leukomalacia, intracranial haemorrhage and a cyst on the epiphyseal gland. In the whole group of patients five of them had had epilepsy, and three complex (atypical) febrile convulsions. Eight children had accompanying difficulties such as delays in speech development, mild hemiparesis, sight disturbances, cognitive deficit and nocturnal enuresis. Conclusion: The disorders which are most frequently linked with ADHD are sleep and behavioural disorders, tics, depression, anxiety, socialization difficulties, problems with sight and hearing, epilepsy, neurometabolic diseases and brain tumours. An analysis of our results shows that ADHD very rarely appears as an isolated disorder without comorbidities. Epilepsy is the most frequent disorder and it occurs in ten patients in our group. The experience of a multidiscipline team shows that the best results in treatment of AHDH are attained by using a combination of drugs and various psychosocial and psycho-educational methods.

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