ADHD

ATTENTION-DEFICITHIPERACTIVITY
DISORDER

PENDAHULUAN

KEPUSTAKAAN PERTAMA OLEH GEORGE STILL

(1902) YANG MENYEBUTKAN BERUPA DEFISIT OF
MORAL KONTROL
STRAUSS DAN LEHTINEN (1947) MENGUNAKAN
MBDS minimal brain damage syndrome
CLEMENT DAN PETERS (1962) Abnormalitas pada
fungsi ini tanpa dapat dibuktikan kerusakan otak.
Kelainan ATENSI dan Kelainan neurologi pada
lobus frontalis dan sirkuit frontostriatsal, berupa
abnormalitas transmisi dopamin.

KRITERIA DIAGNOSTIK DSM-IV

1. Enam atau lebih gejala kurang mampu

memperhatikan terus menerus sekurangkurangnya 6 bulan
a. Sering mendapat kesulitan untuk tetap memperhatikan
dalam kegiatan tugas atau permainan.
b. Sering seakan tidak mendengarkan kalau diajak bicara
secara langsung.
c. Sering tidak memahami instruksi dan gagal
menyelesaikan pekerjaan sekolah, pekerjaan sehari-hari
atau kantor (bukan berupa penantangan).
d. Sering mendapatkan kesulitan mengatur tugas atau
kegiatan

Kriteria diagnosis (lanjutan)

1.e. Sering menghindar, tidak suka atau enggan terlalu tekun dalam
tugas yang menuntut upaya mental yang terus menerus.
f. Sering kehilangan benda-benda yng diperlukan untuk tugas/ kegiatan
g. Sering gampang terganggu oleh rangsangan yang berlebihan
h. Sering alpa dalam kegiatan sehari-hari.

2. Enam atau lebih gejala hiperaktifitas-impulsivitas terus menerus sekurang-kurangnya 6 bulan sampai satu tingkat yang tidak bisa diterima atau tidak kosisten dengan tingkat pertumbuhan.
Hiperaktivitas.
a Tangan dan kaki tidak bisa diam atau duduk dengan gelisah
b. Sering meninggalkan kursi di kelas atau dalam situasi lainnya
ketika diharapakan duduk dengan manis.

Diagnosis lanjutan

2.c.Sering lari kesana kemari atau banyak memanjat-manjat

dalam situasi diharapkan duduk manis
d. Sering tidak bisa diam ketika bermain atau
menggunakan waktu luang.
e. Sering bergerak terus atau sering bertindak seakan
didorong sebuah motor
f. Sering mengomong terus-menerus.

Impulsivitas.
a. Sering menjawab sebelum pertanyaan selesai
b. Sering tidak sabar menunggu giliran
c. Sering menyela orang lain (mis. Menyela pembicaraan
atau permainan.

Diagnosis lanjutan

B. Beberapa gejala hiperaktif-impulsif atau kurang mampu

memperhatikan yang menyebabkan kelemahan itu telah
muncul sebelum usia 7 tahun.
C. Beberapa kelemahan dari gejala-gejala muncul dalam 2
latar atau lebih (mis. Disekolah, dirumah, kantor)
D. Harus ada bukti yang jelas tentang kelemahan yang
mencolok secara klinis dalam fungsi sosial, akademik atau
pekerjaan.
E. Gejala-gejala itu tidak terus menerus selama terjadi
suatu kelainan perkembangan menahun, skizoftrenia,atau
kelainan psikotik lainnya dan tidak lebih disebabkan oleh
kelainan mental lainnya (misalnya kelainan suasana hati,
kecemasan, kelainan nonsosiatif, atau kelainan
kepribadian.)

INATTENTION
KELAINAN DASAR ADALAH LEMAHNYA ATENSI

Parents may say

When I tell her something it goes in one ear and out the
other
I know he can attend; he plays Nintendo for hours.
He knows all the baseball players but he cant
remember what I said a minute ago.
Teacher may say:
Sometimes he just seems to be in outer space
When I call on him, he never seems to have the right
place in reading
She just has so much trouble following instructions.

Impulsivity

Parents may say

He`s 10 years old, but still interrupts my conversations.
He`s got such a short fuse-you never know what to expect.
I`m afraid to let her ride her bike in the street; she`s had
so many accidents.
Teachers may say:
You really have to watch this preschooler all the time.
Other students tease him a lot-they know how to get him to
react.
he has much difficulty waiting to be called; he often just
blurts out an answer.

Hyperactivity

Parents may say:

He was overactive even before he was born.
This toddler is always in motion.
When we visit friends she has to touch
everything.
Teachers may say:
He just can`t stay seated very long.
she`s always talking to her neighbor in class.
His drumming that pencil is really annoying.

Disorganization

Parents may say:

Her room is always a mess.
He`s always losing things. He just can`t get organized.
If I ask him to tuch his shirt in, even more of it is out
when he`s fixed it.
Teachers may say:
He can`t even seem to find things that he needs
Before doing classwork, she`ll take out a pencil, put it
way, try to find paper, take out another pencil and
sharpenit. It take forever for her to get started.
His desk is so messy he can`t find anyting.

Poor sib/peer relations (social problems)

Parents may say:

She says she has no friends.
Before medications, he was the last one to be asked to a
child`s party.
when he`s in a group, he acts like an idiot.
Teacher may say:
He`s such a loner-no one seems to likee him. Sametimes I
think he doesn`t finish his work so that he can stay in and
avoid recess.
She gets so hurt when her classmates avoid her.
He has a real problem playing by the rules at recess.

Aggressive behavior

Parents may say:

He`s always picking on his brother.
She seems to defy me when I ask her to do
samething.
When this kid gets angry, he`s like a wild personyou can`t control him.
Teachers may say:
this child is so many discipline notices- i`m
beginning to think he enjoys it.
when there is trouble, this kid is always involved.

Poor self-concept/self-esteem

Parents may say:

He says he`s stupid.
He seems to get along better with younger
kids and other that have problems.
She says she has no friends.
Teachers may say:
Nobady wants to play with this child.
He seems to give up so easily-he doesn`t try
anymore.
He makes fun of himself and gets loughs.

Neurobiologi ADHD
Berkurangnya volume prefrontal
hemisfer kanan>kiri
Kadang-kadang reduksi dari ganglia
basalis inti kaudatus kiri
Reduksi dari volume serebelum.

PENATALAKSANAAN
Obat stimulan
Obat stimulan, simpatomimetik secara struktural
sama dengan katekolamin endogen bekerja secara
sentral dan perifer dengan meningkatkan dopamin
dan nonadrenergic-transmission
Stimulan memperbaiki kemampuan kognitif, performan sekolah dan tingkah laku.
Methylpenidate memfasilitasi aktifitas dopaminergik pada
Beberapa bagian otak, dan perbaikan hiperaktif dan impulsif dengan menurunkan stimulasi dopaminergik pada bagian otak yang lain.