Attention Deficit /Hyperactivity Disorder

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Attention Deficit /Hyperactivity Disorder

• Diagnosis and Treatment

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ADHD Overview

• -3-10 of school age children
• -Male to female ratio 31
• -Known genetic and environmental contributions
• -Co-occurs or masquerades as mood,anxiety
  ,conduct disorders
• -80 ADHD children grow into ADHD adults
• -Untreated have higher risk for school /work
  problems and underachievement
• -ADHD adolescents more likely to use substances
  and drop out of school

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ADHD Diagnosis

• -No specific biological marker/test
• -Purely behaviorally defined
• -Get patient/family/teacher history(Vanderbilt
  Rating Scales)
• -Interview and exam
• -Psychological testing may be needed

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Diagnostic Criteria

• -6 or more symptoms of inattention and/or
  hyperactivity-impulsivity
• -Persistence for at least 6 months to a degree
  that performance at home or school adversely
  effected
• -Symptoms usually begin before 7 yo

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Symptoms of Inattention

• -Frequent or careless mistakes
• -Difficulty sustaining attention
• -Difficulty following instructions
• -Difficulty completing tasks
• -Poor organizational skills
• -Distraction by minimal extraneous stimuli
• -Forgetfulness

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Symptoms of Hyperactivity and Impulsivity

• -Restlessness and fidgeting
• -Difficulty sitting still
• Extreme degree of motor activity
• -Excessive talking
• -Interrupting
• -Intrusiveness
• -Difficulty in working quietly

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Associated symptoms

• -Overemotionality
• -Academic underachievement
• -Low self esteem
• -Interpersonal Difficulties

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Comorbid Conditions

• -Behavioral disordersoppositional
  defiant/conduct disorders 30-50
• -Depression 30
• -Bipolar disorder 20
• -Anxiety disorder 25
• -Learning disorder 25
• -Tic disorder 20

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Management of ADHD/Educational

• -Identify learning disorders
• -Appropriate academic placement
• -Diagnosis of ADHD confers eligibility for
  special education services
• -Goal is for more on task behavior and less
  disruption in the classroom

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Management of ADHD/Behavioral

• -Identify any comorbid psychiatric conditions
• -Investigate psychosocial factors-home situation
• -School psychologist may contribute with further
  testing
• -Work with students on organizational/planning
  skills

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Management of ADHD/Medical

• -Reserve medication for those who have not
  succeeded with behavioral interventions and have
  functional impairment
• -Stimulants and Non stimulants
• -Usually see response in 1-2 weeks

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Treatment Goals

• Improved attention
• Task completion
• Accuracy
• Memory
• Organizational skills
• Following through on directions

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Treatment Goals

• -Decreased impulsivity/hyperactivity
• Decreased aggression/defiance
• Improved compliance/rule following
• Decreased fidgeting and restlessness
• Decreased talking out of turn

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Results

• -Improved behavior and productivity
• -Improved academic performance
• -Improved peer status and social relations