Neurological Soft Signs in Children with Attention Deficit Hyperactivity Disorder

Article excerpt

Byline: V. Patankar, J. Sangle, Henal. Shah, M. Dave, R. Kamath

Context: Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with wide repercussions. Since it is etiologically related to delayed maturation, neurological soft signs (NSS) could be a tool to assess this. Further the correlation of NSS with severity and type of ADHD and presence of Specific Learning Disability (SLD) would give further insight into it. Aims: To study neurological soft signs and risk factors (type, mode of delivery, and milestones) in children with ADHD and to correlate NSS with type and severity of ADHD and with co-morbid Specific Learning Disability. Settings and Design: The study was carried out in Child care services of a tertiary teaching urban hospital. It was a cross-sectional single interview study. Materials and Methods : 52 consecutive children diagnosed as having ADHD were assessed for the presence of neurological soft signs using Revised Physical and Neurological Examination soft Signs scale (PANESS). The ADHD was rated by parents using ADHD parent rating scale. Statistical Analysis: The data was analyzed using the chi-squared test and Pearson's co-relational analysis. Results and Conclusions: Neurological soft signs are present in 84% of children. They are equally present in both the inattentive-hyperactive and impulsive-hyperactive types of ADHD. The presence of neurological soft signs in ADHD are independent of the presence of co-morbid SLD. Dysrrhythmias and overflow with gait were typically seen for impulsive-hyperactive type and higher severity of ADHD is related to more errors.

Introduction

Attention deficit hyperactivity disorder (ADHD) is believed to be the most common childhood behavioral disorder in children, affecting around 5.2% of school-age population globally. [sup][1] ADHD may affect certain areas of the brain that allow problem solving, planning ahead, understanding others' actions, and impulse control. [sup][2],[3] ADHD is a neuro-developmental disorder characterized by inattention, hyperactivity/impulsivity, or combined, some symptoms of which must be present before the age of 7 years and impairment must be observable in at least two settings. It is two to four times more common in boys. Inattention probably reflects problems with the executive functions of memory. [sup][4],[5] However, delay in the development (by 3 yrs), specially of the frontal and parietal cortex was believed to be responsible for the ability to control and focus thinking. In contrast, the motor cortex in the ADHD patients was seen to mature faster than normal, suggesting that both slower development of behavioral control and advanced motor development might be required for the fidgetiness or hyperactivity that characterizes ADHD. [sup][6]

Impulse control lags (of about 3-5 years when compared to normal children) because inhibitory impairments are thought to involve voluntary or executive inhibition of prepotent responses rather than impulsiveness that may be more motivationally controlled. [sup][7] Mounting evidence further shows that these inhibitory deficits are not a function of other psychiatric disorders that may overlap with ADHD. [sup][8] Regarding etiology, there's a growing consensus that the condition has neurobiological underpinnings. A general reduction of brain volume was found with the core ADHD features of inattention, hyperactivity, and impulsivity reflecting frontal lobe dysfunction but other brain regions particularly the cerebellum had also been implicated. [sup][8],[9]

Neurological Soft Signs (NSS) are non-normative performance on a neurological examination of motor and sensory functioning in the absence of a focal lesion. They are poor coordination, speed or accuracy of limb or axial movements, including those required to keep the balance, dysrhythmias, and overflow are often found during the clinical examination of young children. [sup][10] They are studied in terms of timed and untimed motor movements. …