A 9 year old child disturbs other people, is destructive interfares when two people are talking, does not follow instructions and cannot wait for his turn while playing a game. He is likely to be suffering from __________

ADHD: Attention Deficit Hyperactivity disorder. Difficulty in paying attention, difficulty in controlling behaviour and hyperactivity. Etiology- both genetic and environmental factors. Abnormality in dopamine transpoer and thyroid receptor beta genes in some patients. Inattention behaviour:- 1. Early distraction by extraneous stimuli 2. Careless mistakes in school 3. Difficulty sustaining attention in tasks or play 4. Forgetful in daily activities. 5. Does not seem to listen to what is being said 6. Daydreams, easily confused, move slowly. 7. Fails to finish schoolwork 8. Difficulty in processing information as quickly and accurately as others. Hyperactive behavior:- 1. Runs about or climbs excessively inappropriately 2. Fidgets with hands and feet 3. Trouble sitting still during dinner, school 4. Difficulty doing quiet tasks or activities Impulsive behavior:- 1. Difficulty awaiting turns in games 2. Blus out answers to question 3. Interrupts conversations Three subtypes are known: 1. Predominantly hyperactive impulsive 2. Predominantly inattendive 3. Combined hyperactive impulsive and inattentive. Diagnosis is primarily clinical, using thorough clinical interview of parents and use of behaviour rating scales. Physical examination includes direct observation of child and ruling out chronic systemic illnesses that affect child&;s attention span. Management: Educating the parents Treatment involves combination of behavior therapy and medications. Drugs :- Stimulants ( methylphenidate, anphetamine and their derivatives) are effective in ameliorating inattention, hyperactivity and impulsivity. Atomoxetine, a selective norepinephrine reuptake inhibitor and extended release preparations of selective alpha adrenergic agonists( guanfacine, clonidine) has proved to be effective. Reference: GHAI Essential pediatrics, 8th edition