Chickenpox

Symptoms
Red, quite itchy, spots or blisters are typically scattered over the entire body, spreading to the arms, legs and face. The condition, caused by the varicella zoster virus, most commonly occurs during the first decade of life. The child has a moderate fever and mild flu-like symptoms prior to the rash becoming apparent. It's possible for some children to have these early symptoms and to develop little or no rash, yet still to acquire longterm immunity from the condition. As a rule, the older the infected child is, the more severe the disease.

Incubation period Between 10 to 20 days from being exposed to the infection and showing symptoms. Infectious period Chickenpox is highly contagious from a few days before the disease breaks out until the last blister has crusted over, which usually occurs within a week of the first spots appearing. The child should be excluded from school during this time and avoid contact especially with pregnant women who have not previously had the condition and anyone who is known to have a compromised immune system, eg receiving chemotherapy. The condition is transmitted through droplet infection from coughing or sneezing and from the fluid within the blistering ras

Whooping cough Symptoms Whooping cough is a bacterial infection affecting the respiratory system, caused by the bacterium Bordetella pertussis. The condition is characterised by fever, nasal discharge and long fits of coughing followed by wheezy breathing and possibly vomiting. Symptoms are typically worse at night. Treatment Antibiotic treatment is usually successful leading to a full recovery. Fresh air is important. Because of the risk of vomiting, the child should be given small meals more often, instead of a few large ones. Incubation period This begins from seven days after exposure to the condition.

Infectious period The disease is especially contagious during the first week, while the child still has a trace of a cold. Although the irritating cough has been known to go on for up to 3 months, the infectiousness wears off within five to seven weeks. It is important to keep the child away from other children under the age of one year. Children should be excluded from school until they have completed five days of antibiotic treatment. Prevention In the UK, children are vaccinated against the condition with a series of three injections, one month apart starting at 2 months; and again with a 'pre-school booster' injection aged between 3 and 4 years. 'Fifth' disease (erythema infectiosum) Symptoms The condition is due to infection with Parvovirus B19. The child will sometimes initially develop mild flulike symptoms. All will eventually have red specks, firstly on the cheeks, and later spreading to involve the arms, thighs and buttocks. These are often blurred which makes it look like the child has been slapped. For this reason, fifth disease is often known as 'slapped cheek' syndrome. It can last up to 14 days and is mostly seen in children between the ages of 4 and 12. Treatment It cannot be treated, but disappears by itself. It is usually quite a mild illness. Incubation period Two weeks between being exposed to the infection and showing symptoms. Infectious period Once the rash appears, the disease is no longer infectious. Complications Pregnant women should avoid being in contact with children with fifth disease as it may cause a miscarriage.

Pregnant women with a child who contracts fifth disease should contact their doctor. The incubation period is a couple of weeks. Three-day-fever (roseola infantum) Symptoms A child with three-day-fever has a high fever for three days. The fever then drops and the child develops a rash consisting of pale, reddish spots, perhaps with small heads. It affects the body and spreads to the arms and legs, lasting for about 12-14 hours. Then its over. It is mostly seen in children under the age of three years. Treatment Undress the child to ensure they aren't too warm. Give the child fever reducing medication (such as paracetamol (eg Calpol) and ibuprofen (eg Junifen)) to control their temperature and plenty of fluids to avoid dehydration. Incubation period Between 10 to 15 days from being exposed to the infection and showing symptoms. Infectiousness It is contagious during the whole period of the disease and up to two to three days after. Avoid contact with other children less than three years of age during the whole period. Children may go back to childcare when their temperature has returned to normal. Hand, foot and mouth disease Symptoms This condition can be due to a number of different enteroviruses, causing the child to develop a large number of small spots and blisters, particularly in the mouth and on the feet and hands. The disease can cause a fever of up to 39C for a few days. Treatment As with most diseases causing a fever, it is important to make sure the child gets plenty to drink. If the ulcers in their mouth are severe it may help to mash up the child's food. Incubation period Two to three days between being exposed to the infection and showing symptoms. Infectious period

The disease is contagious as long as blisters or spots are still present. Once the rash has disappeared the child is able to return to child care/school once they are considered to be well enough to do so. Scarlet fever Symptoms This condition is caused by a strain of streptococcus bacterium and is caught through droplet infection from the coughs and sneezes of an infected individual. The child has a slight to moderate fever, a sore throat and a flushed face. The characteristic rash, which is often located in their armpits or groin, spreading to the torso and neck is typically slightly rough to the touch and pink-red in colour. The child's skin peels and they get a coarse, pink tongue a condition known as strawberry tongue. Treatment Antibiotics are usually given for this disease. It is important to keep the child at home and avoid contact with other children. Incubation period Three to eight days between being exposed to the infection and showing symptoms. Infectiousness Scarlet fever is contagious for the first few days, but after three days of antibiotics the risk is almost gone. The disease remains contagious for between 10 days and 3 weeks if left untreated. Children should be excluded from school for five days after commencing antibiotic treatment.

1. RSV

Respiratory syncytial virus (RSV) is a very common childhood illness. It's even more common than seasonal flu. "It causes a lot more problems for children than influenza does," says Michael Brady, MD, an infectious disease expert at Nationwide Children's Hospital, in Columbus, Ohio.

Most of us have had exposure to RSV (respiratory syncytial virus) by the time we're 2 years old. RSV causes some of the same symptoms as cold and flu, such as fever, runny nose, and cough.

For babies less than 1 year old, RSV is the most common cause of pneumonia and bronchiolitis, an inflammation of the small air passages in the lungs. Wheezing is a telltale symptom of these conditions, which sometimes have to be treated in the hospital. Only about 25% to 40% of young children with their first RSV infection will have any noticeable wheezing, however. Even fewer, 2% or less, are hospitalized.

RSV infections last about one to two weeks. You're not immune to RSV once you've had it. You can have an RSV infection at any age, but "after you get it a few times, it's just a cold to you," Brady says.

2. Fifth Disease

Fifth disease has been called the "slapped cheek" disease because it causes a red rash on the face that looks like a slap mark. A lacy red rash may also appear on the child's torso and limbs. Fifth disease doesn't always make a child feel ill, but it can feel like a cold early on, before the rash shows up.

The cryptic name is a holdover from medical lingo a century ago, when a French physician assigned numbers to the common childhood diseases characterized by rashes. For example, measles was "first disease," scarlet fever was "second disease," and so on.

We now know that fifth disease is caused by a virus called human parvovirus B19. Up to 20% of children may get the virus before age 5, and up to 60% have had it by age 19. Infections are usually not very serious and go away in seven to 10 days. Many children infected with the virus don't show any symptoms. "In most cases, it's a pretty benign situation," Brady says.

However, sometimes infection with parvovirus B19 can lead to new onset of joint pain and be mistaken for rheumatoid arthritis. These joint symptoms usually go away within three weeks. 3. Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease is not to be confused with foot-and-mouth disease, which infects only livestock. A common childhood illness, hand, foot, and mouth disease causes a fever with blisters or

sores inside the mouth and on the palms and soles of the feet. The blisters may also appear on the buttocks, "but we decided to leave that out of the name," Brady says.

Hand, foot, and mouth disease is caused by a variety of viruses called enteroviruses. In the United States, the disease is usually caused by a virus known as coxsackievirus A16. This virus usually goes around in the summer and early fall.

Hand, foot, and mouth disease may cause a lot of discomfort, but for most children it isn't very serious and goes away on its own after a week to 10 days.

4. Croup

Croup is a childhood illness usually caused by a group of viruses called human parainfluenza viruses, which also cause the common cold. The main symptom of croup is a "barking" cough, sometimes likened to the barking sound a seal makes. Croup can be serious enough to require treatment in a hospital. Up to 6% of children with croup are hospitalized, but it is very rarely fatal. For severe cases, treatment helps to keep the sick child breathing normally until the infection ends. A case of croup typically lasts about one week.

It's estimated that six in 100 children get croup each year. Children who get it tend to be younger than 6 years old, and it's seen most frequently in 2-year-old children.

5. Scarlet Fever

Scarlet fever is a rash that sometimes appears with strep throat -- an infection with a bacterium called group A streptococcus. A child with strep throat will usually have a very sore throat and high fever. The scarlet fever rash starts on the chest and abdomen and spreads all over the body. It is bright red like sunburn and feels rough like sandpaper. The color of the rash may be deeper around the armpits. The child's tongue may have a whitish appearance, except for the taste buds, which look bright red, a symptom known as "strawberry tongue." There may be some flushing in the face, with a paler area around the mouth.

Scarlet fever was once a feared and deadly childhood illness, but it is easily cured with antibiotics. Now scarlet fever is just another kind of rash.

6. Impetigo

Impetigo is a bacterial skin infection. It's the third most common skin condition in children, seen most often in children aged 2 to 6 years. It's very contagious, and adults can get it, too.

Impetigo appears on the skin as clusters of itchy little bumps or sores that weep fluid, forming a honeycolored crust over them. Touching the fluid from the sores can spread an impetigo infection to the skin on different parts of the child's body, as well as to other people.

Prescription antibiotics are needed to clear up an impetigo infection. The sores heal without causing scars. 7. Kawasaki Disease

Kawasaki disease is a very rare childhood illness with no known cause. It is a peculiar combination of symptoms including a high fever, rash, red palms and soles of the feet, swollen hands and feet, bloodshot eyes, swollen lymph glands, and chapped lips. The disease can cause the vessels of the heart to become inflamed, damaging the heart. In the hospital, doctors treat Kawasaki disease with high doses of drugs that boost the body's immune response. Most children recover with treatment, but the disease is sometimes fatal.

A doctor named Tomisaku Kawasaki first discovered the disease in Japan in the 1960s. It's still most common in Japan, but each year in the U.S., hospitals admit about 4,000 children suffering from Kawasaki disease. Most of them are children younger than age 5.

Whatever makes these children sick has eluded researchers for decades. But an idea that has some traction among scientists, Brady says, is that an infection, maybe a virus, triggers this reaction in children who have a certain genetic trait.

8. Reye's Syndrome

Reye's syndrome is a very serious but now extremely rare childhood illness. If you've ever wondered why you shouldn't give aspirin to children, Reye's is the reason. Reye's syndrome comes on suddenly after a viral illness like chickenpox or the flu. It causes liver problems and brain swelling, leading to radical behavior and personality changes, loss of conscious, seizures, and coma. About 30% of children who have fallen ill with Reye's syndrome die from it.

The cause of Reye's syndrome is still unknown, but there's a lot of evidence to suggest that it's somehow related to taking aspirin during a viral illness.

The CDC first warned about the possible link between aspirin and Reye's syndrome in 1980. Afterward, the number of cases reported each year fell sharply, from 555 cases reported in 1980, to no more than two per year between 1994 and 1997. "It really isn't something we see more than once every 10 years now," Brady tells WebMD.

9. Whooping Cough (Pertussis)

Pertussis, or "whooping cough," is a contagious bacterial infection. Adults and children can get the disease, but infants tend to become more severely ill with it. It's called whooping cough because it can cause a child to cough so hard and so rapidly that he runs out of breath and must inhale deeply, making a "whooping" sound.

According to the CDC, more than half of babies under 12 months old who get pertussis have to be treated in the hospital.

All children should get vaccinated against whooping cough. Many adults also need booster shots. Ask your doctor about the vaccine and booster schedules.

Vaccines have made whooping cough much less common than it was in the past, but the number of cases reported each year has been on the rise since the 1980s. The CDC got reports of 27,550 U.S. cases of pertussis in 2010.

That may be because immunity to whooping cough wears off five to 10 years after getting vaccinated, so some adults who were vaccinated during childhood are no longer protected from the disease. Adults who catch whooping cough may not have severe symptoms, and they may pass the infection to young children. About Cerebral Palsy Cerebral palsy is one of the most common congenital (existing before birth or at birth) disorders of childhood. About 500,000 children and adults of all ages in the United States have the condition.

The three types of CP are:

spastic cerebral palsy causes stiffness and movement difficulties athetoid cerebral palsy leads to involuntary and uncontrolled movements ataxic cerebral palsy causes a disturbed sense of balance and depth perception Cerebral palsy affects muscle control and coordination, so even simple movements like standing still are difficult. Other vital functions that also involve motor skills and muscles such as breathing, bladder and bowel control, eating, and learning may also be affected when a child has CP. Cerebral palsy does not get worse over time.

Causes of Cerebral Palsy The exact causes of most cases of CP are unknown, but many are the result of problems during pregnancy in which the brain is either damaged or doesn't develop normally. This can be due to infections, maternal health problems, a genetic disorder, or something else that interferes with normal brain development. Problems during labor and delivery can cause CP in some cases. but this is the exception.

Premature babies particularly those who weigh less than 3.3 pounds (1,510 grams) have a higher risk of CP than babies that are carried full-term, as are other low birth weight babies and multiple births, such as twins and triplets. Brain damage in infancy or early childhood can also lead to CP. A baby or toddler might suffer this damage because of lead poisoning, bacterial meningitis, malnutrition, being shaken as an infant (shaken baby syndrome), or being in a car accident while not properly restrained. Diagnosing Cerebral Palsy CP may be diagnosed very early in an infant known to be at risk for developing the condition because of premature birth or other health problems. Doctors, such as pediatricians and developmental and neurological specialists, usually follow these kids closely from birth so that they can identify and address any developmental delays or problems with muscle function that might indicate CP.

In a baby carried to term with no other obvious risk factors for CP, it may be difficult to diagnose the disorder in the first year of life. Often doctors aren't able to diagnose CP until they see a delay in normal developmental milestones (such as reaching for toys by 4 months or sitting up by 7 months), which can be a sign of CP.

Abnormal muscle tone, poorly coordinated movements, and the persistence of infant reflexes beyond the age at which they are expected to disappear also can be signs. If these developmental milestones are only mildly delayed, the diagnosis of CP may not be made until the child is a toddler.

Preventing Cerebral Palsy In many cases the causes of CP are unknown, so there's no way to prevent it. But if you're having a baby, you can take steps to ensure a healthy pregnancy and carry the baby to term, thus lowering the risk that your baby will have CP.

Before becoming pregnant, it's important to maintain a healthy diet and make sure that any medical problems are managed properly. As soon as you know you're pregnant, proper prenatal medical care (including prenatal vitamins and avoiding alcohol and illegal drugs) is vital. If you are taking any medications, review these with your doctor and clarify if there are any side effects that can cause birth defects.

Controlling diabetes, anemia, hypertension, seizures, and nutritional deficiencies during pregnancy can help prevent some premature births and, as a result, some cases of cerebral palsy.

Once your baby is born there are actions you can take to lower the risk of brain damage, which could lead to CP. Never shake an infant, as this can lead to shaken baby syndrome and brain damage. If you're riding in a car, make sure your baby is properly strapped into an infant car seat that's correctly installed if an accident occurs, the baby will be as protected as possible.

Be aware of lead exposure in your house, as lead poisoning can lead to brain damage. Remember to have your child get his or her immunizations on time these shots protect against serious infections, some of which can cause brain damage resulting in CP.

How Cerebral Palsy Affects Development Kids with CP have varying degrees of physical disability. Some have only mild impairment, while others are severely affected. This depends on the extent of the damage to the brain. For example, brain damage can be very limited, affecting only the part of the brain that controls walking, or can be much more extensive, affecting muscle control of the entire body.

The brain damage that causes CP can also affect other brain functions, and can lead to other medical issues. Associated medical problems may include visual impairment or blindness, hearing loss, food aspiration (the sucking of food or fluid into the lungs), gastroesophageal reflux (spitting up), speech problems, drooling, tooth decay, sleep disorders, osteoporosis (weak, brittle bones), and behavior problems.

Seizures, speech and communication problems, and mental retardation are more common among kids with the most severe forms of CP. Many have problems that may require ongoing therapy and devices such as braces or wheelchairs.

Treatment of Cerebral Palsy Currently there's no cure for cerebral palsy, but a variety of resources and therapies can provide help and improve the quality of life for kids with CP.

Different kinds of therapy can help them achieve maximum potential in growth and development. As soon as CP is diagnosed, a child can begin therapy for movement, learning, speech, hearing, and social and emotional development.

In addition, medication, surgery, or braces can help improve muscle function. Orthopedic surgery can help repair dislocated hips and scoliosis (curvature of the spine), which are common problems associated with CP. Severe muscle spasticity can sometimes be helped with medication taken by mouth or administered via a pump (the baclofen pump) implanted under the skin.

A variety of medical specialists might be needed to treat the different medical conditions. (For example, a neurologist might be needed to treat seizures or a pulmonologist might be needed to treat breathing difficulties.) If several medical specialists are needed, it's important to have a primary care doctor or a CP specialist help you coordinate the care of your child.

A team of professionals will work with you to meet your child's needs. That team may include therapists, psychologists, educators, nurses, and social workers.

Many resources are available to help and support you in caring for your child. Talk to your doctor about finding those in your area. Autism Pervasive developmental disorder - autism; Autistic spectrum disorder Last reviewed: May 16, 2012.

Autism is a developmental disorder that appears in the first 3 years of life, and affects the brain's normal development of social and communication skills.

Causes, incidence, and risk factors

Autism is a physical condition linked to abnormal biology and chemistry in the brain. The exact causes of these abnormalities remain unknown, but this is a very active area of research. There are probably a combination of factors that lead to autism.

Genetic factors seem to be important. For example, identical twins are much more likely than fraternal twins or siblings to both have autism. Similarly, language abnormalities are more common in relatives of autistic children. Chromosomal abnormalities and other nervous system (neurological) problems are also more common in families with autism.

A number of other possible causes have been suspected, but not proven. They involve:

Diet

Digestive tract changes

Mercury poisoning

The body's inability to properly use vitamins and minerals

Vaccine sensitivity

AUTISM AND VACCINES

Many parents are worried that some vaccines are not safe and may harm their baby or young child. They may ask their doctor or nurse to wait, or even refuse to have the vaccine. However, it is important to also think about the risks of not having the vaccination.

Some people believe that the small amount of mercury (called thimerosal) that is a common preservative in multidose vaccines causes autism or ADHD. However, studies have NOT shown this risk to be true.

The American Academy of Pediatrics, and The Institute of Medicine (IOM) agree that no vaccine or component of any vaccine is responsible for the number of children who are currently being diagnosed with autism. They conclude that the benefits of vaccines outweigh the risks.

All of the routine childhood vaccines are available in single-dose forms that do not contain added mercury.

The Centers for Disease Control and Prevention website provides further information.

HOW MANY CHILDREN HAVE AUTISM?

The exact number of children with autism is not known. A report released by the U.S. Centers for Disease Control and Prevention (CDC) suggests that autism and related disorders are more common than previously thought. It is unclear whether this is due to an increasing rate of the illness or an increased ability to diagnose the illness.

Autism affects boys more often than girls. Family income, education, and lifestyle do not seem to affect the risk of autism.

Some doctors believe the increased incidence in autism is due to newer definitions of autism. The term "autism" now includes a wider spectrum of children. For example, a child who is diagnosed with highfunctioning autism today may have been thought to simply be odd or strange 30 years ago.

Other pervasive developmental disorders include:

Asperger syndrome (like autism, but with normal language development)

Rett syndrome (very different from autism, and almost always occurs in females)

Childhood disintegrative disorder (rare condition where a child learns skills, then loses them by age 10)

Pervasive developmental disorder - not otherwise specified (PDD-NOS), also called atypical autism

Symptoms

Most parents of autistic children suspect that something is wrong by the time the child is 18 months old and seek help by the time the child is age 2. Children with autism typically have difficulties in:

Pretend play

Social interactions

Verbal and nonverbal communication

Some children with autism appear normal before age 1 or 2 and then suddenly "regress" and lose language or social skills they had previously gained. This is called the regressive type of autism.

People with autism may:

Be overly sensitive in sight, hearing, touch, smell, or taste (for example, they may refuse to wear "itchy" clothes and become distressed if they are forced to wear the clothes)

Have unusual distress when routines are changed

Perform repeated body movements

Show unusual attachments to objects

The symptoms may vary from moderate to severe.

Communication problems may include:

Cannot start or maintain a social conversation

Communicates with gestures instead of words

Develops language slowly or not at all

Does not adjust gaze to look at objects that others are looking at

Does not refer to self correctly (for example, says "you want water" when the child means "I want water")

Does not point to direct others' attention to objects (occurs in the first 14 months of life)

Repeats words or memorized passages, such as commercials

Social interaction:

Does not make friends

Does not play interactive games

Is withdrawn

May not respond to eye contact or smiles, or may avoid eye contact

May treat others as if they are objects

Prefers to spend time alone, rather than with others

Shows a lack of empathy

Response to sensory information:

Does not startle at loud noises

Has heightened or low senses of sight, hearing, touch, smell, or taste

May find normal noises painful and hold hands over ears

May withdraw from physical contact because it is overstimulating or overwhelming

Rubs surfaces, mouths or licks objects

Seems to have a heightened or low response to pain

Play:

Doesn't imitate the actions of others

Prefers solitary or ritualistic play

Shows little pretend or imaginative play

Behaviors:

"Acts up" with intense tantrums

Gets stuck on a single topic or task (perseveration)

Has a short attention span

Has very narrow interests

Is overactive or very passive

Shows aggression to others or self

Shows a strong need for sameness

Uses repetitive body movements

Signs and tests

All children should have routine developmental exams done by their pediatrician. Further testing may be needed if the doctor or parents are concerned. This is particularly true if a child fails to meet any of the following language milestones:

Babbling by 12 months

Gesturing (pointing, waving bye-bye) by 12 months

Saying single words by 16 months

Saying two-word spontaneous phrases by 24 months (not just echoing)

Losing any language or social skills at any age

These children might receive a hearing evaluation, blood lead test, and screening test for autism (such as the Checklist for Autism in Toddlers [CHAT] or the Autism Screening Questionnaire).

A health care provider experienced in diagnosing and treating autism is usually needed to make the actual diagnosis. Because there is no biological test for autism, the diagnosis will often be based on very specific criteria from a book called the Diagnostic and Statistical Manual IV.

An evaluation of autism will often include a complete physical and nervous system (neurologic) examination. It may also include a specific screening tool, such as:

Autism Diagnostic Interview - Revised (ADI-R)

Autism Diagnostic Observation Schedule (ADOS)

Childhood Autism rating Scale (CARS)

Gilliam Autism Rating Scale

Pervasive Developmental Disorders Screening Test - Stage 3

Children with known or suspected autism will often have genetic testing (looking for chromosome abnormalities) and may have metabolic testing.

Autism includes a broad spectrum of symptoms. Therefore, a single, brief evaluation cannot predict a child's true abilities. Ideally, a team of different specialists will evaluate the child. They might evaluate:

Communication

Language

Motor skills

Speech

Success at school

Thinking abilities

Sometimes people are reluctant to have a child diagnosed because of concerns about labeling the child. However, without a diagnosis the child may not get the necessary treatment and services.

Treatment

An early, intensive, appropriate treatment program will greatly improve the outlook for most young children with autism. Most programs will build on the interests of the child in a highly structured schedule of constructive activities. Visual aids are often helpful.

Treatment is most successful when it is geared toward the child's particular needs. An experienced specialist or team should design the program for the individual child. A variety of therapies are available, including:

Applied behavior analysis (ABA)

Medications

Occupational therapy

Physical therapy

Speech-language therapy

Sensory integration and vision therapy are also common, but there is little research supporting their effectiveness. The best treatment plan may use a combination of techniques.

APPLIED BEHAVIORAL ANALYSIS (ABA)

This program is for younger children with an autism spectrum disorder. It can be effective in some cases. ABA uses a one-on-one teaching approach that reinforces the practice of various skills. The goal is to get the child close to normal developmental functioning.

ABA programs are usually done in a child's home under the supervision of a behavioral psychologist. These programs can be very expensive and have not been widely adopted by school systems. Parents often must seek funding and staffing from other sources, which can be hard to find in many communities.

TEACCH

Another program is called the Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH). TEACCH was developed as a statewide program in North Carolina. It uses picture schedules and other visual cues that help the child work independently and organize and structure their environments.

Though TEACCH tries to improve a child's adaptation and skills, it also accepts the problems associated with autism spectrum disorders. Unlike ABA programs, TEACCH programs do not expect children to achieve typical development with treatment.

MEDICINE

Medicines are often used to treat behavior or emotional problems that people with autism may have, including:

Aggression

Anxiety

Attention problems

Extreme compulsions that the child cannot stop

Hyperactivity

Impulsiveness

Irritability

Mood swings

Outbursts

Sleep difficulty

Tantrums

Currently, only risperidone is approved to treat children ages 5 - 16 for the irritability and aggression that can occur with autism. Other medicines that may also be used include SSRIs, divalproex sodium and other mood stabilizers, and possibly stimulants such as methylphenidate. There is no medicine that treats the underlying problem of autism.

DIET

Some children with autism appear to respond to a gluten-free or casein-free diet. Gluten is found in foods containing wheat, rye, and barley. Casein is found in milk, cheese, and other dairy products. Not

all experts agree that dietary changes will make a difference, and not all studies of this method have shown positive results.

If you are considering these or other dietary changes, talk to both a doctor who specializes in the digestive system (gastroenterologist) and a registered dietitian. You want to be sure that the child is still receiving enough calories, nutrients, and a balanced diet.

OTHER APPROACHES

Beware that there are widely publicized treatments for autism that do not have scientific support, and reports of "miracle cures" that do not live up to expectations. If your child has autism, it may be helpful to talk with other parents of children with autism and autism specialists. Follow the progress of research in this area, which is rapidly developing.

At one time, there was enormous excitement about using secretin infusions. Now, after many studies have been conducted in many laboratories, it's possible that secretin is not effective after all. However, research continues.

Support Groups

For organizations that can provide additional information and help on autism, see autism resources.

Expectations (prognosis)

Autism remains a challenging condition for children and their families, but the outlook today is much better than it was a generation ago. At that time, most people with autism were placed in institutions.

Today, with the right therapy, many of the symptoms of autism can be improved, though most people will have some symptoms throughout their lives. Most people with autism are able to live with their families or in the community.

The outlook depends on the severity of the autism and the level of therapy the person receives.

Complications

Autism can be associated with other disorders that affect the brain, such as:

Fragile X syndrome

Mental retardation

Tuberous sclerosis

Some people with autism will develop seizures.

The stresses of dealing with autism can lead to social and emotional complications for family and caregivers, as well as the person with autism.

Autism

Chicken pox

Measles

kawasshi

asthma

cold What is measles? Measles is a very contagious (easily spread) infection that causes a rash all over your body. It is also called rubeola or red measles.

The measles vaccine protects against the illness. This vaccine is part of the MMR (measles, mumps, and rubella) and MMRV (measles, mumps, rubella, and varicella [chickenpox]) vaccines. Most children get the vaccine as part of their regular shots. This is why measles is rare in the U.S. and Canada.

What causes measles? Measles is caused by a virus. It is spread when an infected person coughs, sneezes, or shares food or drinks. The measles virus can travel through the air. This means that you can get measles if you are near someone who has the virus even if that person doesn't cough or sneeze directly on you.

You can spread the virus to others from 4 days before the rash starts until 4 days after the rash appeared. The virus is most often spread when people first get sick, before they know they have it.

If you have had measles, you can't get it again. Most people born before 1957 have had measles.

What are the symptoms? The first symptoms of measles are like a bad cold-a high fever, a runny nose, sneezing, a sore throat, and a hacking cough. The lymph nodes in your neck may swell. You also may feel very tired and have diarrhea and red, sore eyes. As these symptoms start to go away, you will get red spots inside your mouth, followed by a rash all over your body.

When adults get measles, they usually feel worse than children who get it.

It usually takes 8 to 12 days to get symptoms after you have been around someone who has measles. This is called the incubation period.

How is measles diagnosed? Your doctor will ask you about your symptoms and examine you. If your doctor suspects that you have measles, he or she may do a blood test and/or viral culture.

If you think you have measles, call your doctor so he or she can report the illness to the local health department.

How is it treated? Measles usually gets better with home care. Take medicines to lower your fever. Also, get plenty of rest and drink lots of fluids. Stay away from other people as much as you can so that you don't spread the disease. If your child has measles, keep him or her out of school until at least 4 days after the rash first appeared. Keep your child out longer if he or she is not feeling well. Your doctor may suggest vitamin A supplements if your child has measles.

Most people get better within 2 weeks. But measles can sometimes cause dangerous problems, such as lung infection (pneumonia) or brain swelling (encephalitis). In rare cases, it can even cause seizures or meningitis. If you have been exposed to measles and you have not had the vaccine, you may be able to prevent the infection by getting a shot of immunoglobulin (IG) or the measles vaccine as soon as possible. Babies who are younger than 12 months, pregnant women, and people who have impaired immune systems that can't fight infection may need to get IG if they are exposed to measles.

Why is prevention important? Getting your child vaccinated is important, because measles can sometimes cause serious problems.

False claims in the news have made some parents concerned about a link between autism and vaccines. But studies have found no link between vaccines and autism.1

Measles is one of the most contagious diseases. Outbreaks can easily occur. For instance, a person from another country may have measles and not know it yet. If that person travels outside his or her own country, he or she could spread measles to people who are not immune. Also, if you travel to another country and you are not immune to measles, you may be at risk.

If you don't know whether you're immune to measles and you plan to travel, check with your doctor or local health clinic to see whether you should get the vaccine before you travel. Causes

Most colds are caused by a virus. In fact, there are over 200 types of virus that can cause the common cold. This is why you cant be immunised against a cold.

The viruses that cause colds are spread by sneezing, coughing and hand contact.

Colds are more common in the winter months. Cold weather by itself doesnt increase the chance of getting a cold, but people are in closer contact with each other because they stay indoors. This means theyre more likely to infect each other. Similarly, getting wet or chilled doesnt cause a cold.

Symptoms

Cold symptoms are pretty much the same in children and adults. You might see one or more of the following:

a stuffy or runny nose sneezing sore throat and ears

cough headache red eyes swelling of lymph glands occasionally fever. Often, your child will lose her appetite, and she might even feel sick or vomit. Your child might be miserable or irritable.

The actual symptoms will vary from child to child, and from illness to illness. Usually the symptoms will last anywhere from a few days to a week or more. Your child will usually recover fully without any problems.

Very occasionally there are complications, such as ear infection, laryngitis, croup, or a lower respiratory tract infection, such as bronchiolitis or pneumonia. These are relatively uncommon illnesses compared to the uncomplicated cold, which is widespread.

When to see your doctor

Almost all colds get better without treatment. The best you can do is use the methods described below, in Treatment.

Take your child to see the doctor if he:

wont drink fluids vomits frequently complains of intense headache is pale and sleepy has difficulty breathing

has a high fever that doesnt get better with paracetamol. Also see your doctor if your child doesnt show some improvement in 48 hours, or if youre worried. For more information, you might like to read our article on recognising serious illness.

Tests

Very occasionally your doctor will order a blood test, throat or nasal swab or, rarely, a chest X-ray. But most children with colds dont need any tests.

Treatment

Theres no cure for the common cold. Theres also no specific treatment that will make the cold go away more quickly. Asthma (say: az-muh) is a condition that affects a person's airways, which are also called breathing tubes or bronchial (say: brong-kee-ul) tubes. These tubes lead from the windpipe, or trachea (say: tray-keeuh), into the lungs.

For most kids, breathing is simple: They breathe in through their noses or mouths and the air goes into the windpipe. From there, it travels through the airways and into the lungs. But for kids with asthma, breathing can be a lot more difficult because their airways are very sensitive.

An asthma flare-up, which some people call an asthma attack or episode, happens when a person's airways get swollen and narrower and it becomes a lot harder for air to get in and out of the lungs. Sometimes the swollen airways produce extra mucus, which makes things pretty sticky, so it's easy to see why it's hard to breathe.

Asthma (say: az-muh) is a condition that affects a person's airways, which are also called
breathing tubes or bronchial (say: brong-kee-ul) tubes. These tubes lead from the windpipe, or trachea (say: tray-kee-uh), into the lungs.

For most kids, breathing is simple: They breathe in through their noses or mouths and the air goes into the windpipe. From there, it travels through the airways and into the lungs. But for kids with asthma, breathing can be a lot more difficult because their airways are very sensitive.

An asthma flare-up, which some people call an asthma attack or episode, happens when a person's airways get swollen and narrower and it becomes a lot harder for air to get in and out of the lungs. Sometimes the swollen airways produce extra mucus, which makes things pretty sticky, so it's easy to see why it's hard to breathe. In between flare-ups, a kid's breathing can be totally normal or seem that way. But during a flare-up, it can feel like the person is breathing through a straw. A kid with asthma may wheeze (a whistling sound when he or she breathes), cough, and feel tightness in the chest.

An asthma flare-up can get worse and worse if a kid doesn't use asthma medicine. After an asthma flareup, the airways almost always return to the way they were before, although it can take several days. What Causes an Asthma Flare-Up? Different kids have different triggers things that set off asthma flare-ups. There are a lot of triggers. Some kids are sensitive to allergens (say: ah-lur-jenz), substances that cause allergic reactions in the airways. Common allergens for kids with asthma include:

dust mites (tiny bugs that live in dust) mold (if you've ever been in a damp basement and smelled something funny, it was probably mold) pollen (from trees, grass, and weeds) A lot of kids have asthma flare-ups when they are near furry animals. Cats and dogs both have what's called animal dander in their fur. This is sort of like dandruff, and it's a trigger that can cause a powerful reaction in the airways.

Some substances can trigger flare-ups because they really irritate the airways. These include perfume, chalk dust, and cigarette smoke. Smoking is always a bad idea, especially around someone who has asthma.

Sometimes an infection can be a trigger and set off an asthma flare-up. If a kid comes down with a cold or the flu, his or her airways may become more sensitive than usual. In some kids, cold air itself can

cause an asthma flare-up, and so can exercise. In fact, some kids have what's called exercise-induced asthma. This means they have breathing problems mainly when they exercise. How Is Asthma Treated? Kids who have asthma should try to avoid things that can cause their airways to tighten. But some triggers like cats, colds, and chalk dust can't always be avoided. That's why kids who are sensitive to those things must manage their asthma by taking medication.

Not every kid's asthma is the same, so there are different medicines for treating it. It's not like curing a sore throat or an earache, when everybody gets the same medicine. Instead, the doctor will think about what causes the asthma flare-ups, how fast the flare-ups happen, and how serious they are. Then he or she will decide on the best kind of treatment.

Some kids need to take asthma medication only once in a while, when they have a flare-up. This is called rescue medicine because it works fast to open the airways, so the person can breathe. Other kids may need to take controller medicine every day. Controller medicine works to keep flare-ups from happening. A kid who knows in advance that he or she will be around allergens or other triggers may need to take medication ahead of time that will keep the airways open. And kids who have exerciseinduced asthma can take medication before exercising so they'll be able to finish a race or game.

Whatever their triggers are, kids with asthma can use a peak flow meter to get an idea of how well they are breathing that day and whether they need to take any medicine.

Asthma medicine often is taken through an inhaler (say: in-hay-lur), a plastic tube that holds a container of medicine. You may have seen a friend or someone in school using an inhaler, which is held up to the mouth. A kid holds the inhaler up to his or her mouth and breathes in. The medicine comes out in a mist that goes into the lungs. The medicine in the mist relaxes the airways, so the person can breathe easier.

cancer Cancer i/knsr/, known medically as a malignant neoplasm, is a broad group of various diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the body through the lymphatic system or bloodstream. Not all tumors are cancerous. Benign tumors do not grow uncontrollably, do not invade neighboring tissues, and do not spread throughout the body. There are over 200 different known cancers that afflict humans.[1] Determining what causes cancer is complex. Many things are known to increase the risk of cancer, including tobacco use, certain infections, radiation, lack of physical activity, obesity, and environmental pollutants.[2] These can directly damage genes or combine with existing genetic faults within cells to cause the disease.[3] Approximately five to ten percent of cancers are entirely hereditary. Cancer can be detected in a number of ways, including the presence of certain signs and symptoms, screening tests, or medical imaging. Once a possible cancer is detected it is diagnosed by microscopic examination of a tissue sample. Cancer is usually treated with chemotherapy, radiation therapy and surgery. The chances of surviving the disease vary greatly by the type and location of the cancer and the extent of disease at the start of treatment. While cancer can affect people of all ages, and a few types of cancer are more common in children, the risk of developing cancer generally increases with age. In 2007, cancer caused about 13% of all human deaths worldwide (7.9 million). Rates are rising as more people live to an old age and as mass lifestyle changes occur in the developing world.[4] Signs and symptoms

Main article: Cancer signs and symptoms

Symptoms of cancer metastasis depend on the location of the tumor.

When cancer begins it invariably produces no symptoms with signs and symptoms only appearing as the mass continues to grow or ulcerates. The findings that result depends on the type and location of the cancer. Few symptoms are specific, with many of them also frequently occurring in individuals who have other conditions. Cancer is the new "great imitator". Thus it is not uncommon for people diagnosed with cancer to have been treated for other diseases to which it was assumed their symptoms were due.[5] Local effects Local symptoms may occur due to the mass of the tumor or its ulceration. For example mass effects from lung cancer can cause blockage of the bronchus resulting in cough or pneumonia, esophageal cancer can cause narrowing of the esophagus making it difficult or painful to swallow, and colorectal cancer may lead to narrowing or blockages in the bowel resulting in changes in bowel habits. Masses of breast or testicles may be easily felt. Ulceration can cause bleeding which, if it occurs in the lung, will lead to coughing up blood, in the bowels to anemia or rectal bleeding, in the bladder to blood in the urine, and in the uterus to vaginal bleeding. Although localized pain may occur in advanced cancer, the initial swelling is usually painless. Some cancers can cause build up of fluid within the chest or abdomen.[5] Systemic symptoms General symptoms occur due to distant effects of the cancer that are not related to direct or metastatic spread. These may include: unintentional weight loss, fever, being excessively tired, and changes to the skin.[6] Hodgkin disease, leukemias, and cancers of the liver or kidney can cause a persistent fever of unknown origin.[5] Specific constellations of systemic symptoms, termed paraneoplastic phenomena, may occur with some cancers. Examples include the appearance of myasthenia gravis in thymoma and clubbing in lung cancer.[5] Metastasis Symptoms of metastasis are due to the spread of cancer to other locations in the body. They can include enlarged lymph nodes (which can be felt or sometimes seen under the skin and are typically hard), hepatomegaly (enlarged liver) or splenomegaly (enlarged spleen) which can be felt in the abdomen, pain or fracture of affected bones, and neurological symptoms.[5] Causes

Cancers are primarily an environmental disease with 9095% of cases attributed to environmental factors and 510% due to genetics.[2] Environmental, as used by cancer researchers, means any cause that is not inherited genetically, not merely pollution.[7] Common environmental factors that contribute to cancer death include tobacco (2530%), diet and obesity (3035%), infections (1520%), radiation

(both ionizing and non-ionizing, up to 10%), stress, lack of physical activity, and environmental pollutants.[2] It is nearly impossible to prove what caused a cancer in any individual, because most cancers have multiple possible causes. For example, if a person who uses tobacco heavily develops lung cancer, then it was probably caused by the tobacco use, but since everyone has a small chance of developing lung cancer as a result of air pollution or radiation, then there is a small chance that the cancer developed because of air pollution or radiation. Chemicals Further information: Alcohol and cancer and Smoking and cancer

The incidence of lung cancer is highly correlated with smoking. Cancer pathogenesis is traceable back to DNA mutations that impact cell growth and metastasis. Substances that cause DNA mutations are known as mutagens, and mutagens that cause cancers are known as carcinogens. Particular substances have been linked to specific types of cancer. Tobacco smoking is associated with many forms of cancer,[8] and causes 90% of lung cancer.[9] Many mutagens are also carcinogens, but some carcinogens are not mutagens. Alcohol is an example of a chemical carcinogen that is not a mutagen.[10] In Western Europe 10% of cancers in males and 3% of cancers in females are attributed to alcohol.[11] Decades of research has demonstrated the link between tobacco use and cancer in the lung, larynx, head, neck, stomach, bladder, kidney, esophagus and pancreas.[12] Tobacco smoke contains over fifty known carcinogens, including nitrosamines and polycyclic aromatic hydrocarbons.[13] Tobacco is responsible for about one in three of all cancer deaths in the developed world,[8] and about one in five worldwide.[13] Lung cancer death rates in the United States have mirrored smoking patterns, with increases in smoking followed by dramatic increases in lung cancer death rates and, more recently, decreases in smoking rates since the 1950s followed by decreases in lung cancer death rates in men since 1990.[14][15] However, the numbers of smokers worldwide is still rising, leading to what some organizations have described as the tobacco epidemic.[16] Cancer related to one's occupation is believed to represent between 220% of all cases.[17] Every year, at least 200,000 people die worldwide from cancer related to their workplace.[18] Most cancer deaths caused by occupational risk factors occur in the developed world.[18] It is estimated that approximately 20,000 cancer deaths and 40,000 new cases of cancer each year in the U.S. are attributable to occupation.[19] Millions of workers run the risk of developing cancers such as lung cancer and mesothelioma from inhaling asbestos fibers and tobacco smoke, or leukemia from exposure to benzene at their workplaces.[18]

Diet and exercise Diet, physical inactivity, and obesity are related to approximately 3035% of cancer deaths.[2][20] In the United States excess body weight is associated with the development of many types of cancer and is a factor in 1420% of all cancer deaths.[20] Physical inactivity is believed to contribute to cancer risk not only through its effect on body weight but also through negative effects on immune system and endocrine system.[20] Diets that are low in vegetables, fruits and whole grains, and high in processed or red meats are linked with a number of cancers.[20] A high salt diet is linked to gastric cancer, aflatoxin B1, a frequent food contaminate, with liver cancer, and Betel nut chewing with oral cancer.[21] This may partly explain differences in cancer incidence in different countries for example gastric cancer is more common in Japan with its high salt diet[22] and colon cancer is more common in the United States. Immigrants develop the risk of their new country, often within one generation, suggesting a substantial link between diet and cancer.[23] Infection Main article: Infectious causes of cancer Worldwide approximately 18% of cancer deaths are related to infectious diseases.[2] This proportion varies in different regions of the world from a high of 25% in Africa to less than 10% in the developed world.[2] Viruses are the usual infectious agents that cause cancer but bacteria and parasites may also have an effect. A virus that can cause cancer is called an oncovirus. These include human papillomavirus (cervical carcinoma), Epstein-Barr virus (B-cell lymphoproliferative disease and nasopharyngeal carcinoma), Kaposi's sarcoma herpesvirus (Kaposi's Sarcoma and primary effusion lymphomas), hepatitis B and hepatitis C viruses (hepatocellular carcinoma), and Human T-cell leukemia virus-1 (T-cell leukemias). Bacterial infection may also increase the risk of cancer, as seen in Helicobacter pylori-induced gastric carcinoma.[24] Parasitic infections strongly associated with cancer include Schistosoma haematobium (squamous cell carcinoma of the bladder) and the liver flukes, Opisthorchis viverrini and Clonorchis sinensis (cholangiocarcinoma).[25] Radiation Main article: radiation-induced cancer Up to 10% of invasive cancers are related to radiation exposure, including both ionizing radiation and non-ionizing radiation.[2] Additionally, the vast majority of non-invasive cancers are non-melanoma skin cancers caused by non-ionizing ultraviolet radiation. Sources of ionizing radiation include medical imaging, and radon gas. Radiation can cause cancer in most parts of the body, in all animals, and at any age, although radiation-induced solid tumors usually take 1015 years, and can take up to 40 years, to become clinically manifest, and radiation-induced

leukemias typically require 210 years to appear.[26] Some people, such as those with nevoid basal cell carcinoma syndrome or retinoblastoma, are more susceptible than average to developing cancer from radiation exposure.[26] Children and adolescents are twice as likely to develop radiation-induced leukemia as adults; radiation exposure before birth has ten times the effect.[26] Ionizing radiation is not a particularly strong mutagen.[26] Residential exposure to radon gas, for example, has similar cancer risks as passive smoking.[26] Low-dose exposures, such as living near a nuclear power plant, are generally believed to have no or very little effect on cancer development.[26] Radiation is a more potent source of cancer when it is combined with other cancer-causing agents, such as radon gas exposure plus smoking tobacco.[26] Unlike chemical or physical triggers for cancer, ionizing radiation hits molecules within cells randomly. If it happens to strike a chromosome, it can break the chromosome, result in an abnormal number of chromosomes, inactivate one or more genes in the part of the chromosome that it hit, delete parts of the DNA sequence, cause chromosome translocations, or cause other types of chromosome abnormalities.[26] Major damage normally results in the cell dying, but smaller damage may leave a stable, partly functional cell that may be capable of proliferating and developing into cancer, especially if tumor suppressor genes were damaged by the radiation.[26] Three independent stages appear to be involved in the creation of cancer with ionizing radiation: morphological changes to the cell, acquiring cellular immortality (losing normal, life-limiting cell regulatory processes), and adaptations that favor formation of a tumor.[26] Even if the radiation particle does not strike the DNA directly, it triggers responses from cells that indirectly increase the likelihood of mutations.[26] Medical use of ionizing radiation is a growing source of radiation-induced cancers. Ionizing radiation may be used to treat other cancers, but this may, in some cases, induce a second form of cancer.[26] It is also used in some kinds of medical imaging. One report estimates that approximately 29,000 future cancers could be related to the approximately 70 million CT scans performed in the US in 2007.[27] It is estimated that 0.4% of cancers in 2007 in the United States are due to CTs performed in the past and that this may increase to as high as 1.52% with rates of CT usage during this same time period.[28] Prolonged exposure to ultraviolet radiation from the sun can lead to melanoma and other skin malignancies.[29] Clear evidence establishes ultraviolet radiation, especially the non-ionizing medium wave UVB, as the cause of most non-melanoma skin cancers, which are the most common forms of cancer in the world.[29] Non-ionizing radio frequency radiation from mobile phones, electric power transmission, and other similar sources have been described as a possible carcinogen by the World Health Organization's International Agency for Research on Cancer.[30] Heredity Main article: Cancer syndrome The vast majority of cancers are non-hereditary ("sporadic cancers"). Hereditary cancers are primarily caused by an inherited genetic defect. Less than 0.3% of the population are carriers of a genetic

mutation which has a large effect on cancer risk and these cause less than 310% of all cancer.[31] Some of these syndromes include: certain inherited mutations in the genes BRCA1 and BRCA2 with a more than 75% risk of breast cancer and ovarian cancer,[31] and hereditary nonpolyposis colorectal cancer (HNPCC or Lynch syndrome) which is present in about 3% of people with colorectal cancer,[32] among others. Physical agents Some substances cause cancer primarily through their physical, rather than chemical, effects on cells.[33] A prominent example of this is prolonged exposure to asbestos, naturally occurring mineral fibers which are a major cause of mesothelioma, a type of cancer of the serous membrane.[33] Other substances in this category, including both naturally occurring and synthetic asbestos-like fibers such as wollastonite, attapulgite, glass wool, and rock wool, are believed to have similar effects.[33] Nonfibrous particulate materials that cause cancer include powdered metallic cobalt and nickel, and crystalline silica (quartz, cristobalite, and tridymite).[33] Usually, physical carcinogens must get inside the body (such as through inhaling tiny pieces) and require years of exposure to develop cancer.[33] Physical trauma resulting in cancer is relatively rare.[34] Claims that breaking bone resulted in bone cancer, for example, have never been proven.[34] Similarly, physical trauma is not accepted as a cause for cervical cancer, breast cancer, or brain cancer.[34] One accepted source is frequent, long-term application of hot objects to the body. It is possible that repeated burns on the same part of the body, such as those produced by kanger and kairo heaters (charcoal hand warmers), may produce skin cancer, especially if carcinogenic chemicals are also present.[34] Frequently drinking scalding hot tea may produce esophageal cancer.[34] Generally, it is believed that the cancer arises, or a pre-existing cancer is encouraged, during the process of repairing the trauma, rather than the cancer being caused directly by the trauma.[34] However, repeated injuries to the same tissues might promote excessive cell proliferation, which could then increase the odds of a cancerous mutation. There is no evidence that inflammation itself causes cancer.[34] Hormones Some hormones play a role in the development of cancer by promoting cell proliferation.[35] Hormones are important agents in sex-related cancers such as cancer of the breast, endometrium, prostate, ovary, and testis, and also of thyroid cancer and bone cancer.[35] An individual's hormone levels are mostly determined genetically, so this may at least partly explains the presence of some cancers that run in families that do not seem to have any cancer-causing genes.[35]

For example, the daughters of women who have breast cancer have significantly higher levels of estrogen and progesterone than the daughters of women without breast cancer. These higher hormone levels may explain why these women have higher risk of breast cancer, even in the absence of a breastcancer gene.[35] Similarly, men of African ancestry have significantly higher levels of testosterone than men of European ancestry, and have a correspondingly much higher level of prostate cancer.[35] Men of Asian ancestry, with the lowest levels of testosterone-activating androstanediol glucuronide, have the lowest levels of prostate cancer.[35] However, non-genetic factors are also relevant: obese people have higher levels of some hormones associated with cancer and a higher rate of those cancers.[35] Women who take hormone replacement therapy have a higher risk of developing cancers associated with those hormones.[35] On the other hand, people who exercise far more than average have lower levels of these hormones, and lower risk of cancer.[35] Osteosarcoma may be promoted by growth hormones.[35] Some treatments and prevention approaches leverage this cause by artificially reducing hormone levels, and thus discouraging hormone-sensitive cancers.[35] Other Excepting the rare transmissions that occur with pregnancies and only a marginal few organ donors, cancer is generally not a transmissible disease. The main reason for this is tissue graft rejection caused by MHC incompatibility.[36] In humans and other vertebrates, the immune system uses MHC antigens to differentiate between "self" and "non-self" cells because these antigens are different from person to person. When non-self antigens are encountered, the immune system reacts against the appropriate cell. Such reactions may protect against tumour cell engraftment by eliminating implanted cells. In the United States, approximately 3,500 pregnant women have a malignancy annually, and transplacental transmission of acute leukaemia, lymphoma, melanoma and carcinoma from mother to fetus has been observed.[36] The development of donor-derived tumors from organ transplants is exceedingly rare. The main cause of organ transplant associated tumors seems to be malignant melanoma, that was undetected at the time of organ harvest.[37] Cancer from one organism will usually grow in another organism of that species, as long as they share the same histocompatibility genes,[38] proven using mice; however this would never happen in a real-world setting except as described above. In non-humans, a few types of transmissible cancer have been described, wherein the cancer spreads between animals by transmission of the tumor cells themselves. This phenomenon is seen in dogs with Sticker's sarcoma, also known as canine transmissible venereal tumor,[39] as well as devil facial tumour disease in Tasmanian devils. Pathophysiology

Main article: Carcinogenesis

Cancers are caused by a series of mutations. Each mutation alters the behavior of the cell somewhat. Cancer is fundamentally a disease of failure of regulation of tissue growth. In order for a normal cell to transform into a cancer cell, the genes which regulate cell growth and differentiation must be altered.[40] The affected genes are divided into two broad categories. Oncogenes are genes which promote cell growth and reproduction. Tumor suppressor genes are genes which inhibit cell division and survival. Malignant transformation can occur through the formation of novel oncogenes, the inappropriate overexpression of normal oncogenes, or by the under-expression or disabling of tumor suppressor genes. Typically, changes in many genes are required to transform a normal cell into a cancer cell.[41] Genetic changes can occur at different levels and by different mechanisms. The gain or loss of an entire chromosome can occur through errors in mitosis. More common are mutations, which are changes in the nucleotide sequence of genomic DNA. Large-scale mutations involve the deletion or gain of a portion of a chromosome. Genomic amplification occurs when a cell gains many copies (often 20 or more) of a small chromosomal locus, usually containing one or more oncogenes and adjacent genetic material. Translocation occurs when two separate chromosomal regions become abnormally fused, often at a characteristic location. A wellknown example of this is the Philadelphia chromosome, or translocation of chromosomes 9 and 22, which occurs in chronic myelogenous leukemia, and results in production of the BCR-abl fusion protein, an oncogenic tyrosine kinase. Small-scale mutations include point mutations, deletions, and insertions, which may occur in the promoter region of a gene and affect its expression, or may occur in the gene's coding sequence and alter the function or stability of its protein product. Disruption of a single gene may also result from integration of genomic material from a DNA virus or retrovirus, and resulting in the expression of viral oncogenes in the affected cell and its descendants. Replication of the enormous amount of data contained within the DNA of living cells will probabilistically result in some errors (mutations). Complex error correction and prevention is built into the process, and safeguards the cell against cancer. If significant error occurs, the damaged cell can "self-destruct" through programmed cell death, termed apoptosis. If the error control processes fail, then the mutations will survive and be passed along to daughter cells. Some environments make errors more likely to arise and propagate. Such environments can include the presence of disruptive substances called carcinogens, repeated physical injury, heat, ionising radiation, or hypoxia[42] The errors which cause cancer are self-amplifying and compounding, for example:

A mutation in the error-correcting machinery of a cell might cause that cell and its children to accumulate errors more rapidly. A further mutation in an oncogene might cause the cell to reproduce more rapidly and more frequently than its normal counterparts. A further mutation may cause loss of a tumour suppressor gene, disrupting the apoptosis signalling pathway and resulting in the cell becoming immortal. A further mutation in signaling machinery of the cell might send error-causing signals to nearby cells. The transformation of normal cell into cancer is akin to a chain reaction caused by initial errors, which compound into more severe errors, each progressively allowing the cell to escape the controls that limit normal tissue growth. This rebellion-like scenario becomes an undesirable survival of the fittest, where the driving forces of evolution work against the body's design and enforcement of order. Once cancer has begun to develop, this ongoing process, termed clonal evolution drives progression towards more invasive stages.[43] Diagnosis

Chest x-ray showing lung cancer in the left lung. Most cancers are initially recognized either because of the appearance of signs or symptoms or through screening. Neither of these lead to a definitive diagnosis, which requires the examination of a tissue sample by a pathologist. People with suspected cancer are investigated with medical tests. These commonly include blood tests, X-rays, CT scans and endoscopy. Classification Further information: List of cancer types and List of oncology-related terms Cancers are classified by the type of cell that the tumor cells resemble and is therefore presumed to be the origin of the tumor. These types include: Carcinoma: Cancers derived from epithelial cells. This group includes many of the most common cancers, particularly in the aged, and include nearly all those developing in the breast, prostate, lung, pancreas, and colon. Sarcoma: Cancers arising from connective tissue (i.e. bone, cartilage, fat, nerve), each of which develop from cells originating in mesenchymal cells outside the bone marrow.

Lymphoma and leukemia: These two classes of cancer arise from hematopoietic (blood-forming) cells that leave the marrow and tend to mature in the lymph nodes and blood, respectively. Leukemia is the most common type of cancer in children accounting for about 30%.[44] Germ cell tumor: Cancers derived from pluripotent cells, most often presenting in the testicle or the ovary (seminoma and dysgerminoma, respectively). Blastoma: Cancers derived from immature "precursor" cells or embryonic tissue. Blastomas are more common in children than in older adults. Cancers are usually named using -carcinoma, -sarcoma or -blastoma as a suffix, with the Latin or Greek word for the organ or tissue of origin as the root. For example, cancers of the liver parenchyma arising from malignant epithelial cells is called hepatocarcinoma, while a malignancy arising from primitive liver precursor cells is called a hepatoblastoma, and a cancer arising from fat cells is called a liposarcoma. For some common cancers, the English organ name is used. For example, the most common type of breast cancer is called ductal carcinoma of the breast. Here, the adjective ductal refers to the appearance of the cancer under the microscope, which suggests that it has originated in the milk ducts. Benign tumors (which are not cancers) are named using -oma as a suffix with the organ name as the root. For example, a benign tumor of smooth muscle cells is called a leiomyoma (the common name of this frequently occurring benign tumor in the uterus is fibroid). Confusingly, some types of cancer also use the -oma suffix, examples including melanoma and seminoma. Some types of cancer are named for the size and shape of the cells under a microscope, such as giant cell carcinoma, spindle cell carcinoma, and small cell carcinoma. Pathology The tissue diagnosis given by the pathologist indicates the type of cell that is proliferating, its histological grade, genetic abnormalities, and other features of the tumor. Together, this information is useful to evaluate the prognosis of the patient and to choose the best treatment. Cytogenetics and immunohistochemistry are other types of testing that the pathologist may perform on the tissue specimen. These tests may provide information about the molecular changes (such as mutations, fusion genes, and numerical chromosome changes) that has happened in the cancer cells, and may thus also indicate the future behavior of the cancer (prognosis) and best treatment.

mumps Mumps (epidemic parotitis) is a viral disease of the human species, caused by the mumps virus. Before the development of vaccination and the introduction of a vaccine, it was a common childhood disease worldwide. It is still a significant threat to health in the third world, and outbreaks still occur sporadically in developed countries.[1] Painful swelling of the salivary glands classically the parotid gland is the most typical presentation.[2] Painful testicular swelling (orchitis) and rash may also occur. The symptoms are generally not severe in children. In teenage males and men, complications such as infertility or subfertility are more common, although still rare in absolute terms.[3][4][5] The disease is generally self-limiting, running its course before receding, with no specific treatment apart from controlling the symptoms with pain medication. Fever and headache are prodromal symptoms of mumps, together with malaise and anorexia. Other symptoms of mumps can include dry mouth, sore face and/or ears and occasionally in more serious cases, loss of voice. In addition, up to 20% of persons infected with the mumps virus do not show symptoms, so it is possible to be infected and spread the virus without knowing it.[6] Males past puberty who develop mumps have a 30 percent risk of orchitis,[7] painful inflammation of the testicles.[8] Cause

Mumps is a contagious disease that is spread from person to person through contact with respiratory secretions, such as saliva from an infected person. When an infected person coughs or sneezes, the droplets aerosolize and can enter the eyes, nose, or mouth of another person. Mumps can also be spread by sharing food and drinks. The virus can also survive on surfaces and then be spread after contact in a similar manner. A person infected with mumps is contagious from approximately 6 days before the onset of symptoms until about 9 days after symptoms start.[9][10] The incubation period (time until symptoms begin) can be from 1425 days, but is more typically 1618 days.[11] [edit]Diagnosis

A physical examination confirms the presence of the swollen glands. Usually, the disease is diagnosed on clinical grounds, and no confirmatory laboratory testing is needed. If there is uncertainty about the diagnosis, a test of saliva or blood may be carried out; a newer diagnostic confirmation, using real-time nested polymerase chain reaction (PCR) technology, has also been developed.[12] An estimated 20%30% of cases are asymptomatic.[13] As with any inflammation of the salivary glands, serum amylase is often elevated.[14][15] [edit]Prevention

The most common preventative measure against mumps is a vaccination with a mumps vaccine, invented by American microbiologist Maurice Hilleman at Merck.[16] The vaccine may be given separately or as part of the MMR immunization vaccine which also protects against measles and rubella. In the US, MMR is now being supplanted by MMRV, which adds protection against chickenpox. The WHO (World Health Organization) recommends the use of mumps vaccines in all countries with wellfunctioning childhood vaccination programmes. In the United Kingdom it is routinely given to children at age 13 months with a booster at 35 years(preschool) This confers lifelong immunity. The American Academy of Pediatrics recommends the routine administration of MMR vaccine at ages 1215 months and at 46 years.[17] In some locations, the vaccine is given again between 4 to 6 years of age, or between 11 and 12 years of age if not previously given. The efficacy of the vaccine depends on the strain of the vaccine, but is usually around 80%.[18][19] The Jeryl Lynn strain is most commonly used in developed countries but has been shown to have reduced efficacy in epidemic situations. The Leningrad-Zagreb strain commonly used in developing countries appears to have superior efficacy in epidemic situations.[20] Because of the outbreaks within college and university settings, many governments have established vaccination programs to prevent large-scale outbreaks. In Canada, provincial governments and the Public Health Agency of Canada have all participated in awareness campaigns to encourage students ranging from grade 1 to college and university to get vaccinated.[21] Some anti-vaccine activists protest against the administration of a vaccine against mumps, claiming that the attenuated vaccine strain is harmful, and/or that the wild disease is beneficial. There is no evidence whatsoever to support the claim that the wild disease is beneficial, or that the MMR vaccine is harmful. Claims have been made that the MMR vaccine is linked to autism and inflammatory bowel disease, including one study by Andrew Wakefield[22][23] (the paper was discredited and retracted in 2010 and Wakefield was later stripped of his license after his work was found to be an "elaborate fraud" [24]) that indicated a link between gastrointestinal disease, autism, and the MMR vaccine. However, subsequent studies indicate no link between vaccination with the MMR and autism.[25] Since the dangers of the disease are well known, while the dangers of the vaccine are quite minimal, most doctors recommend vaccination. The WHO, the American Academy of Pediatrics, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, the American Academy of Family Physicians, the British

Medical Association and the Royal Pharmaceutical Society of Great Britain currently recommend routine vaccination of children against mumps. The British Medical Association and Royal Pharmaceutical Society of Great Britain had previously recommended against general mumps vaccination, changing that recommendation in 1987. In 1988 it became United Kingdom government policy to introduce mass child mumps vaccination programmes with the MMR vaccine, and MMR vaccine is now routinely administered in the UK.[citation needed] Before the introduction of the mumps vaccine, the mumps virus was the leading cause of viral meningoencephalitis in the United States. However, encephalitis occurs rarely (less than 2 per 100,000).[26] In one of the largest studies in the literature, the most common symptoms of mumps meningoencephalitis were found to be fever (97%), vomiting (94%) and headache (88.8%).[27] The mumps vaccine was introduced into the United States in December 1967: since its introduction there has been a steady decrease in the incidence of mumps and mumps virus infection. There were 151,209 cases of mumps reported in 1968. Since 2001, the case average was only 265 per year, excluding an outbreak of >6000 cases in 2006 attributed largely to university contagion in young adults.[28][29] [edit]Treatment

There is no specific treatment for mumps. Symptoms may be relieved by the application of intermittent ice or heat to the affected neck/testicular area and by acetaminophen/paracetamol (Tylenol) for pain relief. Aspirin is not used due to a hypothetical link with Reye's syndrome. Warm salt water gargles, soft foods, and extra fluids may also help relieve symptoms. According to the Department of Health of Minnesota there is no effective post-exposure recommendation to prevent secondary transmission, as well as the post-exposure use of vaccine or immunoglobulin is not effective.[30] Patients are advised to avoid acidic foods and beverages, since these stimulate the salivary glands, which can be painful.[31] Poliomyelitis From Wikipedia, the free encyclopedia (Redirected from Polio) "Polio" redirects here. For the virus, see Poliovirus. Not to be confused with poliosis, a condition of the hair being or becoming white or grey. Poliomyelitis Classification and external resources

A man with an atrophied right leg due to poliomyelitis ICD-10 A80, B91

ICD-9

045, 138 10209 001402 ped/1843 pmr/6

DiseasesDB MedlinePlus eMedicine

MeSH C02.182.600.700 Poliomyelitis (pron.: /poliomalats/), often called polio or infantile paralysis, is an acute, viral, infectious disease spread from person to person, primarily via the fecal-oral route.[1] The term derives from the Greek polis (), meaning "grey", myels ( marrow), referring to the grey matter of the spinal cord, and the suffix -itis, which denotes inflammation.,[2] i.e., inflammation of the spinal cords grey matter, although a severe infection can extend into the brainstem and even higher structures, resulting in polioencephalitis, producing apnea that requires mechanical assistance such as an iron lung. Although approximately 90% of polio infections cause no symptoms at all, affected individuals can exhibit a range of symptoms if the virus enters the blood stream.[3] In about 1% of cases, the virus enters the central nervous system, preferentially infecting and destroying motor neurons, leading to muscle weakness and acute flaccid paralysis. Different types of paralysis may occur, depending on the nerves involved. Spinal polio is the most common form, characterized by asymmetric paralysis that most often involves the legs. Bulbar polio leads to weakness of muscles innervated by cranial nerves. Bulbospinal polio is a combination of bulbar and spinal paralysis.[4] Poliomyelitis was first recognized as a distinct condition by Jakob Heine in 1840.[5] Its causative agent, poliovirus, was identified in 1908 by Karl Landsteiner.[5] Although major polio epidemics were unknown before the late 19th century, polio was one of the most dreaded childhood diseases of the 20th century. Polio epidemics have crippled thousands of people, mostly young children; the disease has caused paralysis and death for much of human history. Polio had existed for thousands of years quietly as an endemic pathogen until the 1880s, when major epidemics began to occur in Europe; soon after, widespread epidemics appeared in the United States.[6] By 1910, much of the world experienced a dramatic increase in polio cases and epidemics became regular events, primarily in cities during the summer months. These epidemics which left thousands of children and adults paralyzed provided the impetus for a "Great Race" towards the development of a vaccine. Developed in the 1950s, polio vaccines have reduced the global number of polio cases per year from many hundreds of thousands to under a thousand today.[7] Enhanced vaccination efforts led by Rotary International, the World Health Organization, and UNICEF should result in global eradication of the disease.[8][9] Poliomyelitis is caused by infection with a member of the genus Enterovirus known as poliovirus (PV). This group of RNA viruses colonize the gastrointestinal tract[1] specifically the oropharynx and the intestine. The incubation time (to the first signs and symptoms) ranges from three to 35 days, with a more common span of six to 20 days.[4] PV infects and causes disease in humans

alone.[3] Its structure is very simple, composed of a single (+) sense RNA genome enclosed in a protein shell called a capsid.*3+ In addition to protecting the viruss genetic material, the capsid proteins enable poliovirus to infect certain types of cells. Three serotypes of poliovirus have been identifiedpoliovirus type 1 (PV1), type 2 (PV2), and type 3 (PV3)each with a slightly different capsid protein.[14] All three are extremely virulent and produce the same disease symptoms.[3] PV1 is the most commonly encountered form, and the one most closely associated with paralysis.[15] Individuals who are exposed to the virus, either through infection or by immunization with polio vaccine, develop immunity. In immune individuals, IgA antibodies against poliovirus are present in the tonsils and gastrointestinal tract, and are able to block virus replication; IgG and IgM antibodies against PV can prevent the spread of the virus to motor neurons of the central nervous system.[16] Infection or vaccination with one serotype of poliovirus does not provide immunity against the other serotypes, and full immunity requires exposure to each serotype.[16] A rare condition with a similar presentation, nonpoliovirus poliomyelitis, may result from infections with nonpoliovirus enteroviruses.[17] [edit]Transmission Poliomyelitis is highly contagious via the oral-oral (oropharyngeal source) and fecal-oral (intestinal source) routes.[16] In endemic areas, wild polioviruses can infect virtually the entire human population.[18] It is seasonal in temperate climates, with peak transmission occurring in summer and autumn.[16] These seasonal differences are far less pronounced in tropical areas.[18] The time between first exposure and first symptoms, known as the incubation period, is usually six to 20 days, with a maximum range of three to 35 days.[19] Virus particles are excreted in the feces for several weeks following initial infection.[19] The disease is transmitted primarily via the fecal-oral route, by ingesting contaminated food or water. It is occasionally transmitted via the oral-oral route,[15] a mode especially visible in areas with good sanitation and hygiene.[16] Polio is most infectious between seven and 10 days before and after the appearance of symptoms, but transmission is possible as long as the virus remains in the saliva or feces.[15] Factors that increase the risk of polio infection or affect the severity of the disease include immune deficiency,[20] malnutrition,[21] tonsillectomy,[22] physical activity immediately following the onset of paralysis,[23] skeletal muscle injury due to injection of vaccines or therapeutic agents,[24] and pregnancy.[25] Although the virus can cross the placenta during pregnancy, the fetus does not appear to be affected by either maternal infection or polio vaccination.[26] Maternal antibodies also cross the placenta, providing passive immunity that protects the infant from polio infection during the first few months of life.[27] As a precaution against infection, public swimming pools were often closed in affected areas during poliomyelitis epidemics. Attention deficit hyperactivity disorder

From Wikipedia, the free encyclopedia (Redirected from ADHD)

Attention-deficit/hyperactivity disorder Classification and external resources

Children with ADHD find it more difficult to focus and to complete their schoolwork. ICD-10 F90 ICD-9 314.00, 314.01

OMIM 143465 DiseasesDB MedlinePlus eMedicine 6158 001551 med/3103 ped/177

MeSH D001289 Attention deficit-hyperactivity disorder (ADHD) is a psychiatric[1] and neurobehavioral disorder[2] characterized by either significant difficulties of inattention or hyperactivity and impulsiveness or a combination of the two. According to the Diagnostic and Statistical Manual of Mental Disorders (DSMIV-TR), symptoms emerge before seven years of age.[3] There are three subtypes of the disorder which consist of it being predominantly inattentive (ADHD-PI or ADHD-I), predominately hyperactive-impulsive (ADHD-HI or ADHD-H), or the two combined (ADHD-C). Oftentimes people refer to ADHD-PI as "attention deficit disorder" (ADD), however, this term has not been officially used since the 1994 version of the DSM. ADHD impacts school-aged children and results in restlessness, acting impulsively, and lack of focus which impairs their ability to learn. It is the most commonly studied and diagnosed psychiatric disorder in children, affecting about 3 to 5 percent of children globally[4][5] and is diagnosed in about 2 to 16 percent of school-aged children.[6] It is a chronic disorder[7] with 30 to 50 percent of those individuals diagnosed in childhood continuing to have symptoms into adulthood.[8] Adolescents and adults with ADHD tend to develop coping mechanisms to compensate for some or all of their impairments.[9] It is estimated that 4.7 percent of American adults live with ADHD.[10] ADHD is diagnosed two to four times more frequently in boys than in girls.[11][12] Its symptoms can be difficult to differentiate from other disorders, increasing the likelihood that the diagnosis of ADHD will be missed.[13] In addition, most clinicians have not received formal training in the assessment and treatment of ADHD, in particular in adult patients.[13]

Standardized rating scales can be used for ADHD screening and assessment of the disorder's symptoms' severity.[14]

ADHD management usually involves some combination of medications, behavior therapy, lifestyle changes, and counseling. Only children with severe ADHD symptoms should be considered for medication as a first-line treatment option. Medication therapy can also be considered for those with moderate ADHD symptoms who either refuse psychotherapeutic options or else fail to respond to psychotherapeutic input.[15]:p.317 ADHD and its diagnosis and treatment have been considered controversial since the 1970s.[16] The controversies have involved clinicians, teachers, policymakers, parents and the media. Topics include ADHD's causes, and the use of stimulant medications in its treatment.[17][18] Most healthcare providers accept ADHD as a genuine disorder with debate in the scientific community centering mainly around how it is diagnosed and treated.[19][20][21] The National Institute for Clinical Excellence, while acknowledging the controversy, states that the current treatments and methods of diagnosis are based on the dominant view of the academic literature.[15]:p.133 Contents [hide] 1 Signs and symptoms 1.1 Associated disorders 1.2 In children who have a high IQ 2 Cause 2.1 Genetics 2.2 Evolution 2.3 Environmental 2.4 Social 3 Pathophysiology 4 Diagnosis 4.1 Classification 4.2 DSM-IV 4.3 ICD-10 4.4 Other guidelines

4.5 Differential 5 Management 5.1 Psychosocial 5.2 Medication 6 Prognosis 7 Epidemiology 8 History 9 Society and culture 9.1 Legal status of medications 9.2 Controversies 10 In adults 11 References 11.1 Bibliography 12 Further reading 13 External links Signs and symptoms

Children with ADHD tend to get distracted from schoolwork rather easily, and they often behave disruptively.[22] Inattention, hyperactivity, disruptive behavior and impulsivity are common in ADHD.[23][22] Academic difficulties are also frequent.[22] The symptoms are especially difficult to define because it is hard to draw a line at where normal levels of inattention, hyperactivity, and impulsivity end and clinically significant levels requiring intervention begin.[13] To be diagnosed with ADHD, symptoms must be observed in two different settings for six months or more and to a degree that is greater than other children of the same age.[24]

The symptom categories yield three potential classifications of ADHDpredominantly inattentive type, predominantly hyperactive-impulsive type, or combined type if criteria for both subtypes are met:[13]:p.4 Predominantly inattentive type symptoms as listed by the U.S. National Institute of Mental Health may include:[25] Be easily distracted, miss details, forget things, and frequently switch from one activity to another Have difficulty maintaining focus on one task Become bored with a task after only a few minutes, unless doing something enjoyable Have difficulty focusing attention on organizing and completing a task or learning something new or trouble completing or turning in homework assignments, often losing things (e.g., pencils, toys, assignments) needed to complete tasks or activities Not seem to listen when spoken to Daydream, become easily confused, and move slowly Have difficulty processing information as quickly and accurately as others Struggle to follow instructions. Predominantly hyperactive-impulsive type symptoms may include:[25] Fidget and squirm in their seats Talk nonstop Dash around, touching or playing with anything and everything in sight Have trouble sitting still during dinner, school, and story time Be constantly in motion Have difficulty doing quiet tasks or activities and also these manifestations primarily of impulsivity:[25] Be very impatient Blurt out inappropriate comments, show their emotions without restraint, and act without regard for consequences Have difficulty waiting for things they want or waiting their turns in games

Most people exhibit some of these behaviors, but not to the degree where such behaviors significantly interfere with a person's work, relationships, or studiesand in the absence of significant interference or impairment, a diagnosis of ADHD is normally not appropriate. The core impairments are consistent even in different cultural contexts.[26] Some children, adolescents, and adults with ADHD have an increased risk of experiencing difficulties with social skills, such as social interaction and forming and maintaining friendships. About half of children and adolescents with ADHD experience rejection by their peers compared to 10-15 percent of non-ADHD children and adolescents. Training in social skills, behavioural modification and medication may have some limited beneficial effects. The most important factor in reducing emergence of later psychopathology, such as major depression, criminality, school failure, and substance use disorders is formation of friendships with people who are not involved in delinquent activities.[27] Adolescents with ADHD are more likely to have difficulty making and keeping friends due to impairments in processing verbal and nonverbal language.[28] Handwriting difficulties seem to be common in children with ADHD.[29] Delays in speech and language as well as motor development occur more commonly in the ADHD population.[29][30][31] A 2009 study found that children with ADHD move around a lot because it helps them stay alert enough to complete challenging tasks.[32][33] Associated disorders Inattention and hyperactive behavior are not necessarily the only problems in children with ADHD. ADHD exists alone in only about 1/3 of the children diagnosed with it. The combination of ADHD with other conditions can greatly complicate diagnosis and treatment. Many co-existing conditions require other courses of treatment and should be diagnosed separately instead of being grouped in the ADHD diagnosis. Some of the associated conditions are: Oppositional defiant disorder and conduct disorder, which occur with ADHD at a rate of 50 percent and 20 percent respectively,[34] are characterized by antisocial behaviors such as stubbornness, aggression, frequent temper tantrums, deceitfulness, lying, or stealing,[35] inevitably linking these comorbid disorders with antisocial personality disorder (ASPD); about half of those with hyperactivity and ODD or CD develop ASPD in adulthood.[36] However, modern brain imaging technology indicates that conduct disorder and ADHD are two distinct conditions.[37] Borderline personality disorder, which was according to a study on 120 female psychiatric patients diagnosed and treated for BPD associated with ADHD in 70 percent of those cases.[38] Primary disorder of vigilance, which is characterized by poor attention and concentration, as well as difficulties staying awake. These children tend to fidget, yawn and stretch and appear to be hyperactive in order to remain alert and active.[35]

Mood disorders (especially Bipolar disorder and Major depressive disorder). Boys diagnosed with the combined subtype have been shown likely to suffer from a mood disorder.[39] Bipolar disorder. Adults with ADHD sometimes have co-morbid bipolar disorder, which requires careful assessment in order to accurately diagnose and treat both conditions.[40] Anxiety disorders, have been found to occur more commonly in the ADHD population.[39] Obsessive-compulsive disorder. OCD can co-occur with ADHD and shares many of its characteristics.[35] Substance use disorders. Adolescents and adults with ADHD are at a significantly increased risk of developing a substance abuse problem which can interfere with the evaluation and treatment of ADHD. The most commonly misused substances by the ADHD population are alcohol and cannabis; serious substance misuse problems should be treated first due to the serious risks and impairments that occur,[15]:p.38[41] with long-term alcohol misuse and long-term cannabis misuse and other drug misuse. There is a strong association between persistent bed wetting and ADHD[42] as well as dyspraxia with up to 50 percent of dyspraxics having ADHD.[43] Multiple research studies have also found a significant association between ADHD and language delay.[44] Anxiety and depression are some of the disorders that can accompany ADHD. Academic studies, and research in private practice suggest that depression in ADHD appears to be increasingly prevalent in children as they get older, with a higher rate of increase in girls than in boys, and to vary in prevalence with the subtype of ADHD. Where a mood disorder complicates ADHD, it would be prudent to treat the mood disorder first, but parents of children with ADHD often wish to have the ADHD treated first, because the response to treatment is quicker.[45] In children who have a high IQ There has been some controversy as to whether ADHD children with a high IQ have significant impairments. Research has shown that high IQ children with ADHD are more likely to repeat grades and have more social and functional impairments; more than half require additional academic support compared to children without ADHD. Additionally, more than half of high IQ ADHD people experience major depressive disorder or oppositional defiant disorder at some point in their lives. Generalised anxiety disorder, separation anxiety disorder and social phobia is also more common in high IQ ADHD individuals. There is some evidence that high IQ ADHD individuals are not at an increased risk of substance abuse and conduct disorder compared to low and average IQ ADHD young people. High IQ children and adolescents with ADHD can have their high intelligence level missed when standard testing is performed; high IQ ADHD people tend to require more comprehensive testing to detect their true intelligence level.[46] High IQ ADHD children have a unique neuropsychological profile which typically shows a gap of 20 points or more between the verbal IQ and the performance IQ when tested on the Wechsler Intelligence Scale for Children; high IQ children without ADHD do not usually present with this sizable gap.[47] Cause

The specific causes of ADHD are not known.[48] There are, however, a number of factors that may contribute to, or exacerbate ADHD. They include genetics, diet and the social and physical environments. Genetics Twin studies indicate that the disorder is highly heritable and that genetics are a factor in about 75 percent of all cases.[15] Hyperactivity also seems to be primarily a genetic condition; however, other causes have been identified.[49] A large majority of ADHD cases may arise from a combination of various genes, many of which affect dopamine transporters. Candidate genes include DAT1, DRD4, DRD5, 5HTT, HTR1B, and SNAP25. There is also strong heterogeneity for the associations between ADHD and DAT1, DRD4, DRD5, dopamine beta hydroxylase, ADRA2A, 5HTT, TPH2, MAOA, and SNAP25.[50] A common variant of a gene called LPHN3 is estimated to be responsible for about 9% of the incidence of ADHD, and ADHD cases where this gene is present are particularly responsive to stimulant medication.[51] Evolution See also: Hunter vs. farmer hypothesis As ADHD is more common than 1 percent of the population, researchers have proposed that due to the high prevalence of ADHD that natural selection has favoured ADHD possibly because the individual traits may be beneficial on their own, and only become dysfunctional when these traits combine to form ADHD.[52] The high prevalence of ADHD may in part be because women in general are more attracted to males who are risk takers, thereby promoting ADHD in the gene pool.[53] Further evidence showing hyperactivity may be evolutionarily beneficial was put forth in 2006 in a study that found it may carry specific benefits for certain forms of society. In these societies, those with ADHD are hypothesized to have been more proficient in tasks involving risk, competition, and/or unpredictable behavior (i.e. exploring new areas, finding new food sources, etc.), where these societies may have benefited from confining impulsive or unpredictable behavior to a small subgroup. In these situations, ADHD would have been beneficial to society as a whole even while severely detrimental to the individual.[53] More recent research suggests that because ADHD is more common in mothers who are anxious or stressed that ADHD is a mechanism of priming the child with the necessary traits for a stressful or dangerous environment, such as increased impulsivity and explorative behaviour etc.[54] A genetic variant associated with ADHD (DRD4 48bp VNTR 7R allele) has been found to be at higher frequency in more nomadic populations and those with more of a history of migration.[55] Consistent with this, another group of researchers observed that the health status of nomadic Ariaal men was higher if they had the ADHD associated genetic variant (7R alleles). However in recently sedentary (nonnomadic) Ariaal those with 7R alleles seemed to have slightly worse health.[56] Environmental

ADHD is predominantly a genetic disorder with environmental factors contributing a small role to the etiology of ADHD. Twin studies have shown that ADHD is largely genetic with 76 percent of the phenotypic variance being explained by inherited genetic factors.[57][58] Alcohol intake during pregnancy can cause the child to have a fetal alcohol spectrum disorder which can include symptoms similar to ADHD.[59] Exposure to tobacco smoke during pregnancy impairs normal development of the feotus including the central nervous system and can increase the risk of the child being diagnosed with ADHD.[60] Many children exposed to tobacco do not develop ADHD or else only have mild symptoms which do not reach the threshold of a diagnosis of ADHD. A combination of a genetic vulnerability to developing ADHD as well as the toxic developmental effects of tobacco on the foetus explain why some children exposed to tobacco smoke in utero develop ADHD and others don't.[61] Children exposed to lead, even relatively low levels of lead develop neurocognitive deficits which resemble ADHD and these children can fulfill the diagnostic criteria for ADHD. There is also some evidence that exposure to polychlorinated biphenyls during childhood causes developmental damage and can cause ADHD type symptoms which are the diagnosed as ADHD.[62] Exposure to the organophosphate insecticides chlorpyrifos and dialkyl phosphate is associated with an increased risk of ADHD. However, the evidence is not definitive as 5 of 17 studies failed to find an association.[63]