ADHD subtypes include:Predominantly inattentivePredominantly hyperactive–impulsiveCombined subtype
It may be further classified as mild, moderate or severe
Management
Behavioural therapy, emotional counselling, specialised educational help and practical support along with parental education are required
Medication (Table 2.1.2)The selection of drugs to manage ADHD depends on the presenting featuresStimulants are the most effective treatment in both children and adultsSedatives and tranquillisers should be avoided as they may impair any associated learning ability or cause a paradoxical reaction such as aggressive behaviourIn some cases, antidepressants and antihypertensive agents have also been successfully administered
Prognosis
ADHD can have a serious and long‐lasting impact on a person's life
By the age of 25, an estimated 15% of people diagnosed with ADHD as children still have a full range of symptoms, and 65% still have some symptoms that affect their daily lives
When symptoms are effectively managed, the quality of the person's life improves – this in turn leads to increased confidence and motivation to continue a healthy pathway towards a meaningful and fulfilling life
Untreated ADHD is very disruptive to a person's day‐to‐day functioning and can cause negative consequences at home, work and school
Adults with untreated ADHD are more likely to develop a substance abuse disorder as they depend on legal and illegal drugs to control their symptomsTable 2.1.2 Medical management of attention deficit and hyperactivity disorder.SymptomMedicationSystemic side‐effectsOral side‐effectsHyperactivity, inattention, impulsivityStimulantsAmphetamineDextroamphetamineMethylphenidateDexmethylphenidateTachycardiaIncrease in blood pressureMotor ticsDyskinesiasErythema multifomeXerostomiaDysgeusiaBruxismNon‐stimulantsAtomoxetineTachycardiaIncrease in blood pressureXerostomiaAntihypertensivesClonidineGuanfacineDrowsinessDizzinessXerostomiaDysgeusiaDysphagiaHyperactivity, inattention and repetitive behavioursAtypical antidepressantsBupropionSuicidal riskAngio‐oedemaXerostomiaDysgeusiaDysphagiaBruxismStomatitisGlossitisTricyclic antidepressants (TCAs)AmitriptylineDesipramineImipramineBlurred visionConstipationWeight gainTachycardiaSuicidal riskXerostomiaDysgeusiaStomatitisSialadentitisAggressive behavioursAntipsychoticsOlanzapineRisperidonePaliperidoneStiffnessRestlessnessWeight gainConstipationXerostomiaSialorrhoeaDysphagiaDysgeusiaStomatitisTongue dyskinesiaAnticonvulsantsCarbamazepineValproateLamotrigineNauseaVomitingDizzinessAngio‐oedemaXerostomiaDysgeusiaStomatitisGlossitis
Impulsive behaviours cause workplace, financial and legal challenges
There is a positive association between ADHD and suicidality in both sexes and in all age groups
A World/Transcultural View
The concept of ADHD first emerged in the USA and from there it spread to all parts of the world during the late 1950s, to be become a global phenomenon
Recent studies have concluded that the global rate of ADHD is approximately 5%
However, there are significant differences in how ADHD has been diagnosed and the support that is available in different countries and regions. This is largely due to variable cultural factors and how conditions associated with behavioural and educational challenges are viewed across the globe
Recommended Reading
1 Bimstein, E., Wilson, J., Guelmann, M., and Primosch, R. (2008). Oral characteristics of children with attention deficit hyperactivity disorder. Spec. Care Dentist. 28: 107–110.
2 Blomqvist, M., Holmberg, K., Fernell, E. et al. (2006). Oral health, dental anxiety, and behavior management problems in children with attention deficit hyperactivity disorder. Eur. J. Oral Sci. 114: 385–390.
3 Broadbent, J.M., Ayers, K.M., and Thomson, W.M. (2004). Is attention deficit hyperactivity disorder a risk factor for dental caries? A case control study. Caries Res. 38: 29–33.
4 Friedlander, A.H., Yagiela, J.A., Mahler, M.E., and Rubin, R. (2007). The pathophysiology, medical management and dental implications of adult attention‐deficit/hyperactivity disorder. J. Am. Dent. Assoc. 138: 475–482.
5 Kemper, A.R., Maslow, G.R., Hill, S., et al. Attention Deficit Hyperactivity Disorder: diagnosis and treatment in children and adolescents. Report No. 18‐EHC005‐EF. Rockville, MD: Agency for Healthcare Research and Quality. (2018).
6 Kerins, C.A., McWhorter, A.G., and Seale, N.S. (2007). Pharmacologic behavior management of pediatric dental patients diagnosed with attention deficit disorder/attention deficit hyperactivity disorder. Pediatr. Dent. 29: 507–513.
7 Souto‐Souza, D., Mourão, P.S., Barroso, H.H. et al. (2020). Is there an association between attention deficit hyperactivity disorder in children and adolescents and the occurrence of bruxism? A systematic review and meta‐analysis. Sleep Med. Rev. 53: 101330.
8 Weibel, S., Menard, O., Ionita, A. et al. (2020). Practical considerations for the evaluation and management of Attention Deficit Hyperactivity Disorder (ADHD) in adults. Encephale 46: 30–40.
2.2 Autism Spectrum Disorders
Section I: Clinical Scenario and Dental Considerations
Clinical Scenario
A 28‐year‐old patient presents to your dental clinic due to self‐injury to the palate using a fork; he is accompanied by his mother. She suspects toothache as the trigger, as her son had previously been putting his fingers into the corner of his mouth and slapping his face on the right side.
Medical History
Autism spectrum disorder
Chronic sleep disorder
Self‐harm episodes
Avoidant/Restrictive food intake disorder (ARFID)
Surgery as a child to correct an aortic stricture
Medications
Haloperidol
Levomepromazine
Biperiden
Dental History
Dental treatment under general anaesthesia 10 years earlier
No previous dental treatment provided with local anaesthesia
Patient brushes his teeth himself 3 times a day (supervised/assisted by his mother twice daily, namely morning and at night)
Still uses the same brand of children's toothpaste as he finds adult toothpastes too strong in taste
Social History
Lives with his parents
His mother is highly involved in taking care of him
During the day, the patient attends a specialised centre and participates in craft workshops
Non‐verbal