ADHD

ATTENTION
DEFICIT
HIPERACTIVITY
DISORDER

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

KRITERIA DIAGNOSTIK DSM-IV

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

e) Sering menghindar, tidak suka atau

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

2. Enam atau lebih gejala hiperaktifitas-impulsivitas terus

menerus sekurang-kurangnya 6 bulan sampai satu
tingkat yang tidak bisa diterima atau tidak kosisten
dengan tingkat pertumbuhan.
a) Hiperaktivitas
a) Tangan dan kaki tidak bisa diam atau duduk dengan
gelisah
b) Sering meninggalkan kursi di kelas atau dalam situasi
lainnya ketika diharapkan duduk dengan manis
c) Sering tidak bisa diam ketika bermain atau
menggunakan waktu luang.
d) Sering bergerak terus atau sering bertindak seakan
didorong sebuah motor
e) Sering mengomong terus-menerus.
b) Impulsivitas.
a) Sering menjawab sebelum pertanyaan selesai
b) Sering tidak sabar menunggu giliran
c) Sering menyela orang lain (mis. Menyela pembicaraan
atau permainan)

 Beberapa gejala hiperaktif-impulsif atau kurang

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

INATTENTION

KELAINAN DASAR ADALAH LEMAHNYA ATENSI

Parents may say

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

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

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

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

Poor sib/peer relations (social problems)

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

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

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

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

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