1. Kashif Hussain, Ph.D. Parasitology, University of Agriculture, Faisalabad.
2. Maria Kausar, M.Phil. Parasitology, University of Agriculture, Faisalabad.
3. Muhammad Sohail Sajid, Associate Prof., Dept. of Parasitology, University of Agriculture, Faisalabad.

What is Attention deficit hyperactivity disorder (ADHD)?

Attention-deficit/hyperactivity disorder (ADHD), a neurodevelopmental syndrome of children, is a condition in which an individual faces hardship to act consciously and control impetuous activities. The patient may be in fidgety and remains continually active[1]. The individual acts without considering the outcome of their doings. It mainly occurs during childhood and can be observed in adults [2]. It is a common disorder of children as about 5% of primary school students are patients of ADHD. Both the genome of an individual and environmental factors are playing a significant role in the occurrence of ADHD [5]. Genetic mutation in dopamine receptor (D4) and transporter (DAT1) gene leads to dysfunction of metabolism of noradrenaline and dopamine, and neurotransmission in cortical and subcortical regions. ADHD due to genetic cause may persist to adulthood [6]. The environmental influencers of ADHD are maternal strain, smoking, malnutrition, prematurity, and prenatal snags. The children with ADHD mainly belong to a chaotic environment. The strengths and difficulties questionnaire can be used as a screening tool for children with such psychiatric disorders [3].

What are the symptoms of Attention deficit hyperactivity disorder (ADHD)?

The condition is characterized by the presence of symptoms of hyperactivity, inattention, and impetuosity. It mainly occurs at age of lesser than 7 years and patients show impairments in various activities (schooling, friendship relation, and home activities). Three sub-groups of ADHD are identified by DSM IV including inattention, hyperactivity, and impetuosity [3]. Many ADHD symptoms, such as high activity levels, difficulty remaining still for long periods, and limited attention spans, are common to young children in general [7]. The variation in ADHD children is the noticeably higher hyperactivity and inattention concerning their age. The condition is diagnosed when the patient exhibit history of 6 months with the manifestation of clinical signs [8]. The condition may be a combination of inattentiveness, and hyperactivity or impetuousness, or any of these types.
Inattentiveness type in an individual observed as
• There is no focus on details and insensible mistakes are encountered during job or schooling.
• Have difficulties to focus on numerous activities or tasks during conversations, lectures, and reading.
• Did not pay attention to listen when talking to them.
• Did not follow instructions to complete schoolwork or job responsibilities.
• Start their job eagerly but lose focus quickly on completion of a task.
• Unable to organize the assigned tasks concerning time management.
• Avoid or hamper to complete tasks that need mental efforts viz, report completion or form filling.
• Losses daily life utilities like keys, books, wallet, school papers, eyeglasses, and cell phone.
• Easily detracted from prime tasks.
• Daily tasks are forgotten viz, running errands and chores, response to phone calls, bills payment, and appointment taking.
Hyperactive or impulsive type exhibit the following symptoms.
• Plays with hands or feet or wriggles in a seat.
• Unable to stay in sitting position during the class or workshop.
• Runs or climbs when it is unsuitable.
• Perform leisure activities silently.
• Too much talking behavior.
• Love to go on the long drive.
• Exclaims the answer before the completion of the question or instant speaking.
• Cannot wait for their turn when standing in a line.
• Interfere others while they were talking and start their own conversation.
There is no specific laboratory test for diagnosis of ADHD, and it can only be diagnosed through history of mental health and psychological behaviour [2, 7].

Pharmacological treatment of ADHD

The therapy of ADHD includes training by parents, support by the school, and a pharmacological approach. The specified medicines are prescribed by child specialists and long-term medication by GPs, but principal pharmacological therapy includes atomoxetine, methylphenidate, and dexamphetamine [4].
1. Atomoxetine, a specified nor-adrenaline re-uptake inhibitor, is appropriately used as the first line of the therapeutic agent but its specified mechanism of action in ADHD is unknown. It is particularly used when the child did not respond to stimulant therapy. It does not interfere with the motor activity (dopamine level in the striatum) so, it did not aggravate Tourette’s. It acts as a sedative agent and prescribes to be taken during the evening because it imposes sleeping. It has a long duration of action up to 24 hours and clinical impacts become fully evident in six weeks following the administration. It has no contraindication when administered with stimulants [9].
2. Methylphenidate is prescribed as the first line of treatment in children against ADHD and about 60 to 80% recovery rate noticed. It acts within 30 minutes following their administration and its side effects include headache, stomach aches, appetite suppression, and sleep disturbance. Whenever there is an emergence of psychotic symptoms methylphenidate should be withdrawn and atomoxetine can be administered [10].
3. Dexamphetamine is rarely prescribed in case of ADHD when atomoxetine and methylphenidate are in effective or when epilepsy worsens [11].


Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental syndrome of children, in which child faces hardship to act consciously and control impetuous activities. It is a common disorder of children as about 5% of children are patients of ADHD. Both the genome of an individual and environmental factors are playing a significant role in the occurrence of ADHD. The condition is characterized by the presence of symptoms of hyperactivity, inattention, and impetuosity. The therapy of ADHD includes parent training, school support, and pharmacological administrations. There is more than 80% recovery rate with early pharmacological therapy and principal pharmacological therapeutic agents include atomoxetine, methylphenidate, and dexamphetamine.


3. Ougrin, D., Chatterton, S. and Banarsee, R., 2010. Attention deficit hyperactivity disorder (ADHD): review for primary care clinicians. London journal of primary care, 3(1), pp.45-51.
4. Swanson, J.M. and Castellanos, F.X., 1998, November. Biological bases of attention deficit hyperactivity disorder: neuroanatomy, genetics, and pathophysiology. In NIH consensus development conference program and abstracts: Diagnosis and treatment of attention deficit hyperactivity disorder (pp. 37-42).
5. Swanson, J.M., Kinsbourne, M., Nigg, J., Lanphear, B., Stefanatos, G.A., Volkow, N., Taylor, E., Casey, B.J., Castellanos, F.X. and Wadhwa, P.D., 2007. Etiologic subtypes of attention-deficit/hyperactivity disorder: brain imaging, molecular genetic and environmental factors and the dopamine hypothesis. Neuropsychology review, 17(1), pp.39-59.
6. Wu, J., Xiao, H., Sun, H., Zou, L. and Zhu, L.Q., 2012. Role of dopamine receptors in ADHD: a systematic meta-analysis. Molecular neurobiology, 45(3), pp.605-620.
7. Simonoff, E., Pickles, A., Wood, N., Gringras, P. and Chadwick, O., 2007. ADHD symptoms in children with mild intellectual disability. Journal of the American Academy of Child & Adolescent Psychiatry, 46(5), pp.591-600.
8. Scheres, A., Dijkstra, M., Ainslie, E., Balkan, J., Reynolds, B., Sonuga-Barke, E. and Castellanos, F.X., 2006. Temporal and probabilistic discounting of rewards in children and adolescents: effects of age and ADHD symptoms. Neuropsychologia, 44(11), pp.2092-2103.
9. Wernicke, J.F. and Kratochvil, C.J., 2002. Safety profile of atomoxetine in the treatment of children and adolescents with ADHD. Journal of Clinical Psychiatry, 63(12), pp.50-55.
10. Matthijssen, A.F.M., Dietrich, A., Bierens, M., Kleine Deters, R., van de Loo-Neus, G.H., van den Hoofdakker, B.J., Buitelaar, J.K. and Hoekstra, P.J., 2019. Continued benefits of methylphenidate in ADHD after 2 years in clinical practice: a randomized placebo-controlled discontinuation study. American Journal of Psychiatry, 176(9), pp.754-762.
11. Ernst, M., Zametkin, A.J., Matochik, J.A., Liebenauer, L., Fitzgerald, G.A. and Cohen, R.M., 1994. Effects of intravenous dextroamphetamine on brain metabolism in adults with attention-deficit hyperactivity disorder (ADHD): preliminary findings. Psychopharmacology Bulletin.