Download Attention-deficit hyperactivity disorder (ADHD). - Pediatrics

Attention-Deficit
/Hyperactivity Disorder
(ADHD)
Dr. Medhat shawkat
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Definition of ADHD
Attention-deficit/hyperactivity disorder describes
children who display persistent age-inappropriate
symptoms of inattention, hyperactivity, and
impulsivity that are sufficient to cause impairment
in major life activities.
(American Psychiatric Association [APA], 2000)
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DSM-IV Criteria for Diagnosis
• Six or more inattention symptoms or six or more
hyperactivity-impulsivity symptoms
• Symptoms must be inconsistent with the child’s
current developmental level
• Must persist to a degree that is considered
maladaptive for at least six months
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Additional DSM Criteria
• Some symptoms present before age 7
• Impairment from symptoms must be present in at least
two types of settings
• Clinically significant impairment in school, social or
occupational functioning
• Symptoms do not occur solely during a pervasive
developmental disorder or psychotic disorder
• Symptoms are not accounted for better by another
mental disorder
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Inattention
1. Often does not give close attention to details or makes careless
mistakes in schoolwork, work, or other activities.
2. Often has trouble keeping attention on tasks or play activities.
3. Often does not seem to listen when spoken to directly.
4. Often does not follow instructions and fails to finish schoolwork,
chores, or duties in the workplace
5. Often has trouble organizing activities.
6. Often avoids, dislikes, or doesn't want to do things that take a lot
of mental effort for a long period of time
7. Often loses things needed for tasks and activities
8. Is often easily distracted.
9. Is often forgetful in daily activities.
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Hyperactivity
1. Often fidgets with hands or feet or squirms in seat.
2. Often gets up from seat when remaining in seat is
expected.
3. Often runs about or climbs when and where it is not
appropriate
4. Often has trouble playing or enjoying leisure activities
quietly.
5. Is often "on the go" or often acts as if "driven by a motor".
6. Often talks excessively.
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Impulsivity
1. Often blurts out answers before questions have
been finished.
2. Often has trouble waiting one's turn.
3. Often interrupts or intrudes on others (e.g., butts
into conversations or games).
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Subtypes
Predominantly Inattentive Type
• children who only meet the criteria for inattention
Predominantly Hyperactive-Impulsive Type
• children who only meet the criteria for hyperactivityimpulsivity
Combined Type
• children who meet the criteria for both inattention and
hyperactivity-impulsivity
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Prevalence Rates
Prevalence: range from 1-10% of children under the age of
18
• North American prevalence rate range from 3-5%
• Worldwide prevalence study: 5.29%
• Higher rates in North America
• Culture does have an impact on the prevalence of
ADHD
• Higher prevalence rates when using teacher reports,
lower prevalence rates when using parent reports
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Facts
• In every classroom of 30 students,
up to 3 children may have ADHD
• ADHD children tend to show
emotional development that is 30%
slower than children without the
disorder
• Up to 65% of children with ADHD
show problems with defiance, noncompliance, problems with authority
figures, show verbal hostility, and
have temper tantrums
• 40% of children with ADHD have
at least one parent with the disorder
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Facts
• 50% of children with ADHD
display sleeping problems as
well
• Parents of ADHD children
are 3 times more likely to
divorce than parents of nonADHD children
• 75% of boys display the
hyperactive-impulsive type of
ADHD, while only 60% of
girls are hyperactive
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Causes of ADHD
•
ADHD is a medical disorder despite many myths
• early theories thought minor head injuries or brain
damage were the cause
• the exact cause is currently unknown, but it is now
thought to be caused by biological factors that influence
neurological activity
• genetic influence
• toxins in the environment
• the use of drugs/alcohol during pregnancy
• environmental/family influence
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Treatment
•A complete medical evaluation should be conducted
•The condition can be diagnosed when appropriate
guidelines are used.
•The treatment of ADHD must involve a multimodal
approach.
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Medication
•Stimulant (most commonly used)
•Non-stimulant
•Antidepressants
•Antihypertensives
•Mood Stabilizers
•Neuroleptic drugs
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Stimulant Medication
•Variety of forms:
•Methylphenidate
•Dextroamphetamine
•Amphetamine
•Lisdexamfetaime
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•For 80% of children with ADHD, Stimulants produce
dramatic increases in:
•Sustained attention
•Impulsive control
•Persistence of work effort
•Decrease in task-irrelevant behavior
•Cooperation
•Physical Coordination
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Behavior Therapies
•Parent Management Training (PMT)
•Parents are taught about ADHD
•Given guidelines for raising a child with ADHD
•For disruptive behavior parents are taught to use
penalties
•Studies support PMT
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Educational Interventions
•Focus on managing inattentive and hyperactiveimpulsive behaviors
•Techniques are similar to those recommended to
parents
•Reward system
-Considerable support for school based
interventions
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Intensive Interventions
•Summer Treatment Programs
•Provided to children between 5-15
•Classroom and recreational activates
•Advantages: peer relationships, and
progress made during school year is not
lost
•Used with medication, PMT, and Educational
Interventions
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Additional Interventions
•Family Counseling and Support Groups
•Helps everyone develop new skills, and attitudes, and
teaches them how to relate more effectively
•Local and National support groups
•On-line bulletin boards
•Individual Counseling
•Teach children with ADHD how to feel better about
one’s self
•Build strengths, cope with daily problems, and control
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attention and aggression
Common Myths About ADHD
• ADHD is equally common among boys and girls, and at
all ages.
• ADHD is usually outgrown
• Children with ADHD are less intelligent
• Faulty parenting is the primary cause of ADHD
• Sugar ingestion is a primary cause of ADHD
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Common Myths About ADHD
• ADHD rating scales follow the same standards for
boys and girls.
• Due to the increase in prevalence rates and rise in
prescriptions, ADHD is highly over-diagnosed
• ADHD symptoms often do not show up in the
preschool years
• Private school is a better option for ADHD children
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How We Can Help
Behaviour Plans:
1.
One is more likely to succeed in changing behaviour by rewarding what is
seen as desired behaviour than by punishing what is seen as undesirable
behaviour
2.
For a plan to work, the responses to acceptable and to unacceptable
behaviours must be consistent and must occur each time. Inconsistent
response patterns may reinforce the negative behaviour
• Providing management structure and routines for students can help
combat some of the problems through the use of:
• Checklists of required materials
• Agenda to keep track of requirements
• Classroom routines to provide consistency for students
• "Learning how to learn" and study skills strategies that provide
structures for completion of assignments
• Breaking assignments down into manageable parts that can be
checked and reinforced
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Bibliography
N.A. (2002). Prevalence of hyperactivity-impulsivity and inattention among candian children. Retrieved October 22,
2008, from Human Resources and Social Development Canada Website:
http://www.hrsdc.gc.ca/en/cs/sp/sdc/pkrf/publications/research/2002-000170/page04.shtml
N.A. (2008). ADHD.ca. Retrieved October 20, 2008, from Eli Lilly and Company Web Site: www.adhd.ca
N.A. (2008). Disorder Information Sheet. Retrieved October 22, 2008, from PsychNet-UK Website:
http://www.psychnet-uk.com/dsm_iv/attention_deficit_disorder.htm
N.A. (2008). Attention Deficit Hyperactivity Disorder (ADHD)-Cause. Retrieved October 25, 2008, from WebMD
Website: http://www.webmd.com/add-adhd/tc/attention-deficit-hyperactivity-disorder-adhd-cause
N.A. (2005). Symptoms of ADHD. Retrieved October 25, 2008, from Department of Health and Human Services
Website: http://www.cdc.gov/ncbddd/adhd/symptom.htm
N.A. (2007). Teaching students with Attention-deficit/ hyperactivity disorder. Retrieved October 22, 2008, from
Province of British Columbia Web site: http://www.bced.gov.bc.ca/specialed/adhd/managed.htm
Barkley, R. (2000). Taking charge of ADHD: The complete, authoritative guide for parents. New York: The Guilford
Publication Inc.
Barkley, R. (2006). Taking charge of ADHD. Retrieved October 19, 2008, from Margo Richter Website:
http://www.adhdnews.com/blog/archives/2006/10/quick_stats_of.html
Boyles, N., & Contadino, D. (1999). Parenting a child with attention deficit/hyperactivity disorder. Chicago:
Contemporary Group, Inc.
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Faraone, V. S., Sergeant, J., Gillberg, C., & Bierderman, J. (2003). The worldwide prevalence of ADHD: is it an
American condition? Retrieved October 20, 2008, from World Psychiatry Website:
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1525089
Mash, E., & Wolfe, D. (2005) Abnormal child psychology. Belmont: Thomson Learning Inc.
Mitchell, B. (2006). ADHD self test. Retrieved October 22, 2008, from Curiosity Media Inc. Web site:
http://www.trustyguides.com/adhd6.html
Rief, S. (1998). The add/adhd checklist: an easy reference for parents & teachers. San Francisco: Jossey-Bass
Schoenstadt, A. (2008). ADHD Treatment. Retrieved October 15, 2008, from (N.A.) Web site:
http://adhd.emedtv.com/adhd/adhd-treatment.html
Silver, L. B. (2004). Attention-deficit hyperactivity disorder: a clinical guide to diagnosis and treatment for
health and mental health professionals. Washington: American Psychiatric Publishing, Inc.
Stein, D. (1999). Ritalin is not the answer: A drug-free, practical program for children diagnosed with ADD or
ADHD. San Francisco: Jossey-Bass Inc.
Swierzewski, S. (2008) Attention-deficit hyperactivity disorder (ADHD). Retrieved October 15, 2008, from (
N.A. Web site: http://www.neurologychannel.com/adhd/medication.shtml#non
The Health Center. (2006). Child ADD/ADHD self test. Retrieved October 22, 2008, from The National Center
for Health and Wellness Web site: http://www.thehealthcenter.info/selftest.php?id=16
Wender, P. H. (2001). Attention-deficit hyperactivity disorder in children, adolescents, and adults. New York:
Oxford University Press.
West, K. (2000). The Positive Side of ADD. Retrieved October 21, 2008, from Lesson Tutor Website:
http://www.lessontutor.com/kw4.html
Wodrich, D. (2000). Attention deficit/hyperactivity disorder: What every parent wants to know. Baltimore: Paul
H. Brooks Publishing Co.
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