Attention-Deficit/Hyperactivity Disorder (ADHD)

সংজ্ঞা (Definition)

ADHD হলো একটি neurodevelopmental disorder যেখানে শিশুর বা বড় মানুষের মনোযোগ ধরে রাখা, অকারণীয় hyperactivity এবং impulsivity নিয়ন্ত্রণ করা কঠিন হয়।

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কারণ / Etiology

ADHD-এর কারণ সম্পূর্ণ বোঝা যায়নি, তবে প্রধান কারণগুলো হলো:

1. Genetic Factors: পরিবারের মধ্যে ADHD থাকলে ঝুঁকি বেশি।
2. Neurobiological Factors: মস্তিষ্কের prefrontal cortex, basal ganglia, এবং dopamine ও norepinephrine neurotransmitter এর অস্বাভাবিকতা।
3. Environmental Factors: ধূমপান, মাতৃর গর্ভকালীন মাদকসেবন, জন্মের আগে বা পরে জটিলতা।
4. Psychosocial Stressors: পরিবারিক অস্থিরতা বা chronic stress কিছু ক্ষেত্রে exacerbate করতে পারে।

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লক্ষণ / Symptoms

ADHD মূলত তিনটি cluster-এ দেখা যায়:

1. Inattentive Type (মনোযোগে সমস্যা)
   • কাজের সময় মনোযোগ ধরে রাখতে পারছে না
   • ভুলের প্রবণতা বেশি
   • দায়িত্ব সম্পন্ন করতে পারছে না
   • সহজেই distract হয়
2. Hyperactive-Impulsive Type
   • স্থির থাকতে পারছে না, অনেক চলাফেরা
   • অপ্রয়োজনীয় দৌড়ঝাঁপ বা হাত-পা নাড়াচাড়া
   • অন্যের কথা না শুনে ফুঁসফুঁস করা
   • দ্রুত সিদ্ধান্ত নিয়ে বিপদ তৈরি করা
3. Combined Type: উপরের দুটি symptom একসাথে থাকে

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Clinical Diagnosis / নির্ণয়

DSM-5 Criteria অনুযায়ী ADHD নির্ণয় করা হয়:

• Symptom কমপক্ষে 6 মাস ধরে থাকতে হবে
• Age of onset: 12 বছরের আগে
• Symptom must interfere with social, academic, or occupational functioning
• Symptom must be present in 2 or more settings (school, home)

Investigation / পরীক্ষা:

• কোনো রক্ত পরীক্ষা নেই যা ADHD নিশ্চিত করে
• Diagnosis প্রধানত clinical assessment (history, observation, teacher reports)
• Rating scales:
  • Conners’ Rating Scale
  • Vanderbilt ADHD Diagnostic Rating Scale
• Occasionally: neuropsychological testing or EEG/MRI to rule out other disorders

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Treatment / Management

1. Pharmacological Treatment (Drug Therapy)

প্রধানত stimulant এবং non-stimulant drugs ব্যবহার করা হয়।

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1. Methylphenidate

Tablet 1.Alaradate 10 mg AS A Methylphenidate Hydrochloride AS A CNS stimulant drugs.

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• Purpose: Dopamine এবং norepinephrine reuptake inhibit করে মনোযোগ এবং hyperactivity control করে
• Generic Name: Methylphenidate
• Dose:
  • Children: 5–20 mg per day, divided dose
  • Adults: 10–60 mg per day, divided dose
• Duration: Symptom control অনুযায়ী, long-term follow-up প্রয়োজন
• Side Effects: Insomnia, decreased appetite, headache, abdominal pain, mild increase in BP/HR
• Interactions: MAO inhibitors (avoid), antihypertensives, anticonvulsants
• Why Used: Improves attention span, decreases impulsivity, enhances executive function

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2. Amphetamine salts (Mixed salts of Amphetamine)

• Purpose: Stimulate CNS, increase dopamine & norepinephrine
• Generic Name: Lisdexamfetamine, Dextroamphetamine Not Availavle in Bd, Atomoxetine Hydrochloride Only Available in bd.
• Capsule 2.Oriham 10 mg AS A Atomoxetine Hydrochloride AS A CNS stimulant drugs.
• Dose:
  • Children: 5–30 mg per day (Lisdexamfetamine)
  • Adults: 20–60 mg per day
• Duration: Long-acting preparation: 10–12 hours effect
• Side Effects: Insomnia, appetite loss, increased BP/HR, anxiety
• Interactions: MAO inhibitors, acidifying/alkalizing agents
• Why Used: Long-acting stimulant for attention improvement, behavioral control

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• Atomoxetine (Non-stimulant)

3.Capsule 2.Oriham 10 mg AS A Atomoxetine Hydrochloride AS A CNS stimulant drugs.

• Purpose: Selective norepinephrine reuptake inhibitor
• Generic Name: Atomoxetine
• Dose:
  • Children: 0.5–1.2 mg/kg/day
  • Adults: 40–100 mg/day
• Duration: Daily, long-term maintenance
• Side Effects: Nausea, vomiting, liver toxicity (rare), sleep disturbance
• Interactions: MAO inhibitors, CYP2D6 substrates
• Why Used: When stimulant contraindicated or anxiety/comorbidities present

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• Guanfacine / Clonidine (Alpha-2 agonist)

Tablet 4.Clonipres 0.1mg AS A Clonidine Hydrochloride AS A Centrally acting antihypertensive drugs (central sympatholytic).

• Purpose: Reduce hyperactivity and impulsivity
• Generic Name: Guanfacine / Clonidine
• Dose:
  • Guanfacine: 1–4 mg/day (children)
  • Clonidine: 0.05–0.4 mg/day
• Side Effects: Hypotension, sedation, dry mouth
• Why Used: Behavioral regulation, often adjunct to stimulants

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Non-Pharmacological Treatment

• Behavioral therapy, parent training, school interventions
• Structured routine, reward system, minimize distractions

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Prevention / প্রতিরোধ

• Genetic prevent impossible, but risk reduction possible:
  1. Healthy pregnancy: avoid alcohol, smoking, illicit drugs
  2. Early identification and behavioral interventions in children
  3. Structured environment and consistent routines
  4. Limit excessive screen time and promote physical activity

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সংক্ষিপ্ত Summary

• ADHD হলো attention deficit + hyperactivity + impulsivity disorder
• Cause: Genetic + neurobiological + environmental
• Diagnosis: Clinical + rating scales, DSM-5 criteria
• Treatment:
  • Stimulants: Methylphenidate, Amphetamines → improve attention & reduce hyperactivity
  • Non-stimulants: Atomoxetine, Guanfacine → alternate/comorbid conditions
• Prevention: Healthy maternal lifestyle, early intervention, structured environment

Drug (Generic Name)	Dose	Duration	Purpose / Use	Side Effects	Interactions	Reason for Use
Methylphenidate	Children: 5–20 mg/day, divided Adults: 10–60 mg/day	Symptom control, long-term	Increases dopamine & norepinephrine → improves attention, reduces hyperactivity	Insomnia, decreased appetite, headache, abdominal pain, mild ↑ BP/HR	MAO inhibitors (avoid), antihypertensives, anticonvulsants	First-line stimulant for attention & behavioral control
Lisdexamfetamine / Dextroamphetamine	Children: 5–30 mg/day (Lisdexamfetamine) Adults: 20–60 mg/day	Long-acting, 10–12 hrs effect	CNS stimulant → increases dopamine & norepinephrine → improves focus & reduces impulsivity	Insomnia, appetite loss, ↑ BP/HR, anxiety	MAO inhibitors, acidifying/alkalizing agents	Long-acting stimulant, useful for school/work hours
Atomoxetine	Children: 0.5–1.2 mg/kg/day Adults: 40–100 mg/day	Daily, maintenance	Selective norepinephrine reuptake inhibitor → improves attention & reduces impulsivity	Nausea, vomiting, liver toxicity (rare), sleep disturbance	MAO inhibitors, CYP2D6 substrates	Non-stimulant option, suitable for anxiety/comorbidity or stimulant intolerance
Guanfacine	Children: 1–4 mg/day	Daily	Alpha-2 agonist → reduces hyperactivity & impulsivity	Hypotension, sedation, dry mouth	Other antihypertensives, CNS depressants	Adjunct for behavioral regulation or stimulant combination
Clonidine	Children: 0.05–0.4 mg/day	Daily	Alpha-2 agonist → reduces hyperactivity, improves sleep	Hypotension, sedation, dry mouth	Antihypertensives, CNS depressants	Used adjunctively to control hyperactivity & insomnia

✅ Key Notes:

• Stimulants (Methylphenidate, Amphetamines) → first-line for attention & hyperactivity.
• Non-stimulants (Atomoxetine, Guanfacine, Clonidine) → used when stimulants contraindicated or comorbid conditions exist.
• Monitoring: Blood pressure, heart rate, growth (children), liver function (Atomoxetine).

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Reference List

1. Textbook: Harrison’s Principles of Internal Medicine, 20th Edition, Chapter 363
2. Guidelines:
   • American Academy of Pediatrics (AAP) Clinical Practice Guideline, 2019
   • NICE Guideline NG87, 2018
3. Journals:
   • Faraone SV, et al. Nat Rev Dis Primers 2015;1:15020. DOI: 10.1038/nrdp.2015.20
   • Cortese S, et al. Lancet Psychiatry 2018;5:727–738. DOI: 10.1016/S2215-0366(18)30269-4

Md.Rafiqul Islam Lipu,Date:-16-05-2026 Thursaday Time:-09-26-57 Pm