overview of adhd (nh edu-health )

7/30/2019 Overview of ADHD (NH Edu-health )

1/36

www.nheduhealth.com 2010 1

OVERVIEW OF ATTENTION

DEFICIT HYPERACTIVITYDISORDER (ADHD)

Dr. Nor Hamidah Mohd Salleh

Consultant PsychiatristM.D.,M.Med.(Psy)


2/36


WHAT IS ADHD

ADHD is a developmental disorderof self control (executive function ofthe brain)

Symptoms arise from abnormalitiesin the brain

Their main problems are

Attention span Impulse control

Activity level


3/36


WHAT IS ADHD

It is not caused by parental failureto discipline or control the child, andit it not a sign of some sort of

inherent badness in the child.

ADHD is a real disorder, a real

problem and often a real obstacle.It can be heartbreaking and nervewrecking.


4/36


TYPES OF ADHD

1. PREDOMINANTLY HYPERACTIVEIMPULSIVE TYPE

A child must have six or more symptoms ofhyperactivity/impulsivity

2. PREDOMINANTLY INATTENTIVETYPE

A child must display six or more symptomsof inattention

3. COMBINED TYPE A child must show six or more symptoms

both of inattention and hyperactivity-impulsivity


5/36


Symptoms of Inattention

Fails to pay close attention to details ormakes careless mistakes

Has difficulty maintaining attention in

tasks or play activities

Does not seem to listen when spoken todirectly

Does not follow directions and fails tocomplete schoolwork, chores, or, inadolescents, on the job duties


6/36


Symptoms of Inattention

Has difficulty organizing tasks oractivities

Avoids or dislike task that requiresustained mental effort

Losses things necessary for task oractivities

Easily distracted

Often forgetful in daily activities


7/36


Symptoms of Hyperactivity

Fidgets with hands or feet orsquirms in seat

Leaves seat in classroom or in othersituation in which remaining seatedis expected

Runs or climbs excessively when

inappropriate


8/36


Symptoms of Hyperactivity

Has difficulty playing or engaging inleisure activities quietly

Always on the go or act as if drivenby a motor

Often talks excessively

In adolescence, may exhibit feelingof restlessness


9/36


Symptoms of Impulsivity

Blurts out answers before questionshave been completed

Has difficulty waiting in turn Interrupts or intrudes on others (for

example butts into conversations orgames)


10/36


WHATS WRONG WITH

ADHD CHILDREN

Research suggests that there is achemical imbalance affecting theneurotransmitters dopamine,norepineprine and serotonin.

An imperfection in the brain thatcauses the constant motion and

other intolerable behavioralproblems in ADHD.


11/36


ADHD Diagnostic Evaluation

1. Physical examination

2. Parent-rated child behavior scales

3. Teacher-rated child behavior scales4. Parent and child interviews

5. Parent self report measures


12/36


ADHD Diagnostic Evaluation

5. Parent self-report measures

6. Clinic-based psychological test

7. Review of prior school andmedical reports

8. Intelligence testing (IQ tests)and educational achievementtesting


13/36


COEXISTING DISORDERS

1. Depressive disorder

2. Anxiety disorders

3. Learning disorders 4. Conduct disorder

5. Bipolar disorder

6. Oppositional defiant disorder


14/36


Why we need to treat ADHD?

1. Neurobiological maturational delay that involvesthe brain executive and cognitive functions

2. A chronic condition that may extend into adulthood

3. The risks if untreated

1. Learning difficulties/disabilities2. Conduct disorder

3. Substance abuse disorder

4. Mood disorder

5. Poor work performance

6. Social problem7. Relationship problem


15/36


When to start treatment?

Early identification and interventionis the best approach that helps toavoid or minimize the risks

Depending on the types andseverity of the ADHD

Early intervention program for

ADHD started as early as 3 yearsold.


16/36


What to expect in treatment of

ADHD?

1. Pharmacotherapy

2. Behavior therapy/cognitive

behavior therapy3. Family therapy/guidance

1. Home management

2. Parenting and stress management

4. Classroom management


17/36


What kind of treatment?

1. Early intervention program (EIP)

2. Middle childhood intervention

program (MCIP)3. Adolescent intervention program

(AIP)

4. Young Adult intervention program(YAIP)


18/36


Early intervention program

1. Preschool children with ADHD/HKD

2. Assessment

1. Types or severity of ADHD (CPRS, CTRS)

2. Co morbidity e.g. speech delay, autistic disorder,

mental retardation, epilepsy3. Temperament

4. Parental awareness and support

5. IQ or general mental ability (WISC, KBIT, DTLA)

6. Speech, social and personal development

7. Quick neurological screening test8. Behavioral and emotional problem

9. Academic ability and placement (WRAT)


19/36


Early Intervention Program

3. Rehabilitation1. Sensory motor integration program2. Speech therapy

4. Academic placement and support

1. Send them early (3-4 years old) to playschool which has sensory motordevelopmental program andtrained/empathic teacher

2. Special educational placement- private, NGOor public is recommended if the child has

learning disability3. Communicate with the school about the

childs developmental problem and establishteacher support program


20/36


Early Intervention Program

5. Home management 8 steps to BetterBehavior

1. Learn to pay positive attention to your child

2. Use your powerful attention to gaincompliance

3. Give more effective commands

4. Teach your child not to interrupt youractivities

5. Set up a home token system6. Learn to punish misbehavior constructively

7. Expand your use of time out

8. Learn to manage your child in public places


21/36


Middle Childhood Intervention

Program

1. Aims1. To improve

attention,behavior, moodand learning

2. To help developfurther the childsneurological,sensory, motor,social andpsychologicalmaturity

3. To provide parentalguidance andfamily therapy


22/36



Program

2. Treatmentapproaches

1. Psychologicaltherapies

1. Behavior/Cognitivebehavior therapy

2. Focus therapy

3. Play therapy

4. Art therapy

5. Relaxation therapy

6. Anger

management7. Social group

therapy


23/36



Program

3. Pharmacotherapy

3. Stimulant, non stimulant monitoring andmaintenance

4. Rehabilitation program

3. For child with delay maturity5. Academic placement and support

3. Consider special placement for children withmoderate to severe learning disability

4. Assess the childs learning aptitude and providesupport accordingly

5. Monitor the child academic progress andattainment

6. Psychological development reassessment yearly

7. Communicate with school about the childs needand behavioral strategies in learning


24/36


Adolescent Intervention Program

1. Aims

1. To improveattention,behavior, mood

and learning2. To help develop

further the childspsychological andsocial maturity

3. To provide parentalguidance andfamily therapy


25/36



2. Assessment2. Co morbidity such as conduct disorder, substance

abuse, mood disorder, adolescent-parent conflictand academic difficulties

3. The adolescents insight into her/his problem4. Parental awareness and support

3. Psychological therapies2. Individual psychotherapy

3. Group therapy

4. Anger management5. Relaxation therapy

6. Family therapy/guidance


26/36



4. Pharmacotherapy1. Stimulants, non stimulants2. Monitoring, dose adjustment and

maintenance3. Consider tailing dose if the child reach

the maturity to cope on his/her own

5. Academic placement and support1. Monitoring of academic progress2.

Reassess the childs psychologicaldevelopment and learning aptitude3. Assess the child potential for future

vocation


27/36


Young Adult Intervention Program

1. Aims1. To improve attention, behavior, mood and

learning

2. To enhance the young adults psychological,intellectual and social maturity

3. To guide them learn and cope effectively intheir chosen vocation

4. To provide parental guidance and familytherapy

5. To provide school guidance and/support


28/36


Young Adult Intervention Program

2. Assessment

3. Psychological therapies

2. Cognitive behavior therapy

3. Supportive psychotherapy

4. Relaxation therapy

5. Individual psychotherapy

6. EEG biofeedback therapy

4. Medications5. Academic placement and support


29/36


Who can treat ADHD?

Specialist with expertise in ADHD

Child and adolescent psychiatrist

Psychiatrist

Clinical psychologist


30/36


Effective Treatment of ADHD

Multidiscipline

Medical

Psychological

Educational Rehabilitation


31/36


Medical Treatment

Medication is used to treat thesymptoms and help the child withADHD function more effectively

Examples are

Ritalin, Stratera and Concerta


32/36


Documented Specific Beneficial Effects

of Stimulants

I. MOTOR EFFECTS

Reduce activity to the level of normalpeers

Decrease excessive talking, noise anddisruption in the classroom

Improve hand writing

Improve the fine motor coordination


33/36


Documented Specific Beneficial

Effects of Stimulants

II. SOCIAL EFFECTS Reduce anger

Reduce bossiness with peers

Reduce verbal and physical aggression withpeers

Reduce defiance and oppositional behaviorwith adults

Decrease intensity of behavior

Improve peer social status Improve ability to play and work independently

Improve mother-child and family interactions


34/36


Documented Specific Beneficial Effects

of Stimulants

COGNITIVE EFFECTS

Improve sustained attention

Improve short term memory

Reduce distractibility

Reduce impulsivity

Increase the amount of academic work

completed Increase the accuracy of academic

work


35/36


THE TEAM

Parents

Family

School officials

Health careprofessionals


36/36

www nheduhealth com 2010 36

GIMC Child Developmental Team

1. Consultant Childand AdolescentPsychiatrist

2. ClinicalPsychologists

3. OccupationalTherapists

4. SpeechTherapists

overview of adhd (nh edu-health )

Documents