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OVERVIEW OF ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)

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OVERVIEW OF ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD) Dr. Nor Hamidah Mohd Salleh Consultant Psychiatrist M.D.,M.Med.(Psy) WHAT IS ADHD ADHD is a developmental ... – PowerPoint PPT presentation

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Title: OVERVIEW OF ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)


1
OVERVIEW OF ATTENTION DEFICIT HYPERACTIVITY
DISORDER (ADHD)
  • Dr. Nor Hamidah Mohd Salleh
  • Consultant Psychiatrist M.D.,M.Med.(Psy)

2
WHAT IS ADHD
  • ADHD is a developmental disorder of self control
    (executive function of the brain)
  • Symptoms arise from abnormalities in the brain
  • Their main problems are
  • Attention span
  • Impulse control
  • Activity level

3
WHAT IS ADHD
  • It is not caused by parental failure to
    discipline or control the child, and it 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
    nerve wrecking.

4
TYPES OF ADHD
  • 1. PREDOMINANTLY HYPERACTIVE IMPULSIVE TYPE
  • A child must have six or more symptoms of
    hyperactivity/impulsivity
  • 2. PREDOMINANTLY INATTENTIVE TYPE
  • A child must display six or more symptoms of
    inattention
  • 3. COMBINED TYPE
  • A child must show six or more symptoms both of
    inattention and hyperactivity-impulsivity

5
Symptoms of Inattention
  • Fails to pay close attention to details or makes
    careless mistakes
  • Has difficulty maintaining attention in tasks or
    play activities
  • Does not seem to listen when spoken to directly
  • Does not follow directions and fails to complete
    schoolwork, chores, or, in adolescents, on the
    job duties

6
Symptoms of Inattention
  • Has difficulty organizing tasks or activities
  • Avoids or dislike task that require sustained
    mental effort
  • Losses things necessary for task or activities
  • Easily distracted
  • Often forgetful in daily activities

7
Symptoms of Hyperactivity
  • Fidgets with hands or feet or squirms in seat
  • Leaves seat in classroom or in other situation in
    which remaining seated is expected
  • Runs or climbs excessively when inappropriate

8
Symptoms of Hyperactivity
  • Has difficulty playing or engaging in leisure
    activities quietly
  • Always on the go or act as if driven by a motor
  • Often talks excessively
  • In adolescence, may exhibit feeling of
    restlessness

9
Symptoms of Impulsivity
  • Blurts out answers before questions have been
    completed
  • Has difficulty waiting in turn
  • Interrupts or intrudes on others (for example
    butts into conversations or games)

10
WHATS WRONG WITH ADHD CHILDREN
  • Research suggests that there is a chemical
    imbalance affecting the neurotransmitters
    dopamine, norepineprine and serotonin.
  • An imperfection in the brain that causes the
    constant motion and other intolerable behavioral
    problems in ADHD.

11
ADHD Diagnostic Evaluation
  • 1. Physical examination
  • 2. Parent-rated child behavior scales
  • 3. Teacher-rated child behavior scales
  • 4. Parent and child interviews
  • 5. Parent self report measures

12
ADHD Diagnostic Evaluation
  • 5. Parent self-report measures
  • 6. Clinic-based psychological test
  • 7. Review of prior school and medical reports
  • 8. Intelligence testing (IQ tests) and
    educational achievement testing

13
COEXISTING DISORDERS
  • 1. Depressive disorder
  • 2. Anxiety disorders
  • 3. Learning disorders
  • 4. Conduct disorder
  • 5. Bipolar disorder
  • 6. Oppositional defiant disorder

14
Why we need to treat ADHD?
  • Neurobiological maturational delay that involves
    the brain executive and cognitive functions
  • A chronic condition that may extend into
    adulthood
  • The risks if untreated
  • Learning difficulties/disabilities
  • Conduct disorder
  • Substance abuse disorder
  • Mood disorder
  • Poor work performance
  • Social problem
  • Relationship problem

15
When to start treatment?
  • Early identification and intervention is the best
    approach that helps to avoid or minimize the
    risks
  • Depending on the types and severity of the ADHD
  • Early intervention program for ADHD started as
    early as 3 years old.

16
What to expect in treatment of ADHD?
  • Pharmacotherapy
  • Behavior therapy/cognitive behavior therapy
  • Family therapy/guidance
  • Home management
  • Parenting and stress management
  • Classroom management

17
What kind of treatment?
  • Early intervention program (EIP)
  • Middle childhood intervention program (MCIP)
  • Adolescent intervention program (AIP)
  • Young Adult intervention program (YAIP)

18
Early intervention program
  • Preschool children with ADHD/HKD
  • Assessment
  • Types or severity of ADHD (CPRS, CTRS)
  • Co morbidity e.g. speech delay, autistic
    disorder, mental retardation, epilepsy
  • Temperament
  • Parental awareness and support
  • IQ or general mental ability (WISC, KBIT, DTLA)
  • Speech, social and personal development
  • Quick neurological screening test
  • Behavioral and emotional problem
  • Academic ability and placement (WRAT)

19
Early Intervention Program
  • Rehabilitation
  • Sensory motor integration program
  • Speech therapy
  • Academic placement and support
  • Send them early (3-4 years old) to play school
    which has sensory motor developmental program and
    trained/empathic teacher
  • Special educational placement- private, NGO or
    public is recommended if the child has learning
    disability
  • Communicate with the school about the childs
    developmental problem and establish teacher
    support program

20
Early Intervention Program
  • Home management 8 steps to Better Behavior
  • Learn to pay positive attention to your child
  • Use your powerful attention to gain compliance
  • Give more effective commands
  • Teach your child not to interrupt your activities
  • Set up a home token system
  • Learn to punish misbehavior constructively
  • Expand your use of time out
  • Learn to manage your child in public places

21
Middle Childhood Intervention Program
  • Aims
  • To improve attention, behavior, mood and learning
  • To help develop further the childs neurological,
    sensory, motor, social and psychological maturity
  • To provide parental guidance and family therapy

22
Middle Childhood Intervention Program
  • Treatment approaches
  • Psychological therapies
  • Behavior/Cognitive behavior therapy
  • Focus therapy
  • Play therapy
  • Art therapy
  • Relaxation therapy
  • Anger management
  • Social group therapy

23
Middle Childhood Intervention Program
  • Pharmacotherapy
  • Stimulant, non stimulant monitoring and
    maintenance
  • Rehabilitation program
  • For child with delay maturity
  • Academic placement and support
  • Consider special placement for children with
    moderate to severe learning disability
  • Assess the childs learning aptitude and provide
    support accordingly
  • Monitor the child academic progress and
    attainment
  • Psychological development reassessment yearly
  • Communicate with school about the childs need
    and behavioral strategies in learning

24
Adolescent Intervention Program
  • Aims
  • To improve attention, behavior, mood and learning
  • To help develop further the childs psychological
    and social maturity
  • To provide parental guidance and family therapy

25
Adolescent Intervention Program
  • Assessment
  • Co morbidity such as conduct disorder, substance
    abuse, mood disorder, adolescent-parent conflict
    and academic difficulties
  • The adolescents insight into her/his problem
  • Parental awareness and support
  • Psychological therapies
  • Individual psychotherapy
  • Group therapy
  • Anger management
  • Relaxation therapy
  • Family therapy/guidance

26
Adolescent Intervention Program
  • Pharmacotherapy
  • Stimulants, non stimulants
  • Monitoring, dose adjustment and maintenance
  • Consider tailing dose if the child reach the
    maturity to cope on his/her own
  • Academic placement and support
  • Monitoring of academic progress
  • Reassess the childs psychological development
    and learning aptitude
  • Assess the child potential for future vocation

27
Young Adult Intervention Program
  • Aims
  • To improve attention, behavior, mood and learning
  • To enhance the young adults psychological,
    intellectual and social maturity
  • To guide them learn and cope effectively in their
    chosen vocation
  • To provide parental guidance and family therapy
  • To provide school guidance and/support

28
Young Adult Intervention Program
  • Assessment
  • Psychological therapies
  • Cognitive behavior therapy
  • Supportive psychotherapy
  • Relaxation therapy
  • Individual psychotherapy
  • EEG biofeedback therapy
  • Medications
  • Academic placement and support

29
Who can treat ADHD?
  • Specialist with expertise in ADHD
  • Child and adolescent psychiatrist
  • Psychiatrist
  • Clinical psychologist

30
Effective Treatment of ADHD
  • Multidiscipline
  • Medical
  • Psychological
  • Educational
  • Rehabilitation

31
Medical Treatment
  • Medication is used to treat the symptoms and help
    the child with ADHD function more effectively
  • Examples are
  • Ritalin, Stratera and Concerta

32
Documented Specific Beneficial Effects of
Stimulants
  • I. MOTOR EFFECTS
  • Reduce activity to the level of normal peers
  • Decrease excessive talking, noise and disruption
    in the classroom
  • Improve hand writing
  • Improve the fine motor coordination

33
Documented Specific Beneficial Effects of
Stimulants
  • II. SOCIAL EFFECTS
  • Reduce anger
  • Reduce bossiness with peers
  • Reduce verbal and physical aggression with peers
  • Reduce defiance and oppositional behavior with
    adults
  • Decrease intensity of behavior
  • Improve peer social status
  • Improve ability to play and work independently
  • Improve mother-child and family interactions

34
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
THE TEAM
  • Parents
  • Family
  • School officials
  • Health care professionals

36
GIMC Child Developmental Team
  • Consultant Child and Adolescent Psychiatrist
  • Clinical Psychologists
  • Occupational Therapists
  • Speech Therapists
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