adhd in children
TRANSCRIPT
Evidence Based Psychosocial Treatment for ADHD in Children
G.Aasritha WilliamPharm-D
ADHD(Attention Deficit Hyperactivity Disorder)• “Attention Deficit Hyperactivity Disorder(ADHD) is a
chronic condition that affects millions of children and often persists into adulthood.”
• Children with ADHD are often hyperactive (overactive) and have difficulty paying attention and staying focused on tasks.
• They may interrupt other people's conversations or be impulsive and impatient.
The Changing Face of ADHD CHILDHOOD
ADULTHOOD
Hyperactivity May Become Restlessness
Physical Impulsivity
May Become Verbal
Impulsivity
Inattention Often Remains Inattention
PATHOPHYSIOLOGY
-Brain studies on individuals with ADHD suggest a defect in the dopamine receptor D4 (DRD4) receptor gene and overexpression of dopamine transporter-1 (DAT1)
-The DRD4 receptor uses DA and NE to modulate attention and responses to one's environment.
The DAT1 or dopamine transporter protein takes DA/NE into the presynaptic nerve terminal so it may not have sufficient interaction with the postsynaptic receptor.
The neurotransmitters dopamine (DA) and norepinephrine (NE) are implicated in the pathophysiology of ADHD.
STATISTICS IN INDIA IN 2013
STUDY CONDUCTED
RESULTS
REFERENCE:Venkata JA, Panicker AS. Prevalence of attention deficit hyperactivity disorder in primary school children . Indian J Psychiatry 2013;55:338-42
PHARMACOLOGICAL TREATMENT
STIMULANTS• methylpheni
date hydrochloride
• dextroamphetamine sulfate
• dextroamphetamine/amphetamine formulation
• methylphenidate
NON- STIMULANTatomoxetine
ANTI DEPRESSANTS• buproprion
hydrochloride
• imipramine
ANTI HYPERTENSIVES• clonidine
hydrochloride
• guanfacine
What works for ADHD?• All of the evidence-based practice elements for use
in ADHD have their basis in Clinical Behavior Therapy (Psychosocial Therapy)
REFERENCE:From the National Institute of Mental Health and Project # U45 MC00174 from the Office of Child Health Bureau, Health Resources and Services Administration, Department of Health and Human Services
What doesn’t work for ADHD?• Treatments with little or no evidence of
effectiveness include– Special elimination diets– Vitamins or other health food remedies– Psychoanalysis– Biofeedback– Play therapy– Sensory integration training– Social skills training– Self-control training
Clinical Behavior Therapy: ‘Theory’
Proposed Mechanism: Individuals with ADHD have difficulty understanding the consequences of their actions.
Approach:Application of principles of social learning theory to modify children’s behavior by training parents and teachers to manipulate environmental antecedents, consequences and contingencies.
ABC model( Antecedent Behavior Consequence )
Contingencies
An example: The ABC Model
The ABC Model
ContingenciesTeacher makes eye contact with student, says, “Take out your math books.”
Specific interventions to help the student with ADHD
• Psycho-education with parent• Parent praise• Commands/limit setting• Response cost• Parent monitoring• Time out• Ignoring
Does acupuncture have a positive effect on school success in children?• OBJECTIVE: • To evaluate school success in pediatric patients
undergoing acupuncture treatment for various indications including ADHD.
• CONCLUSION: • Acupuncture contributed to the academic success
of the children who underwent treatment for their primary symptoms.
Reference:Tas D, Acar HVJ; Tradit Chin Med. 2014 Aug;34(4):450-4.
A review of ADHD in girls:
• OBJECTIVE: To describe the clinical presentation of attention
deficit/hyperactivity disorder (ADHD) in girls and factors influencing proper diagnosis and treatment.• RESULTS: The ADHD prevalence rates are higher among boys than girls. A low
index of clinical suspicion exists for girls; their presentation is considered "subthreshold" because inattentiveness is more prominent than hyperactivity/impulsivity. Females with ADHD may develop better coping strategies than males to mask their symptoms.
REFERENCE:Venkata JA, Panicker AS. Prevalence of attention deficit hyperactivity disorder in primary school children . Indian J Psychiatry 2013;55:338-42
“Never give up on someone with a mental illness. When "I" is replaced by "We", illness becomes wellness.”
THANK YOU
G.Aasritha William