Overview of ADHD (NH Edu-Health)

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

www.nheduhealth.com 2010 1
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

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

A child must show six or more symptoms both of inattention and hyperactivityimpulsivity
www.nheduhealth.com 2010
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
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
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
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
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)
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.
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ADHD Diagnostic Evaluation

1. 2. 3. 4. 5. Physical examination Parent-rated child behavior scales Teacher-rated child behavior scales Parent and child interviews Parent self report measures
11
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
12
COEXISTING DISORDERS
1. 2. 3. 4. 5. 6.
Depressive disorder Anxiety disorders Learning disorders Conduct disorder Bipolar disorder Oppositional defiant disorder
13
Why we need to treat ADHD?

1. Neurobiological maturational delay that involves the brain executive and cognitive functions 2. A chronic condition that may extend into adulthood 3. The risks if untreated
1. 2. 3. 4. 5. 6. 7. Learning difficulties/disabilities Conduct disorder Substance abuse disorder Mood disorder Poor work performance Social problem Relationship problem
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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.
What to expect in treatment of ADHD?

1.
2.
3.
Pharmacotherapy Behavior therapy/cognitive behavior therapy Family therapy/guidance

1.
2.
Home management Parenting and stress management
4.
Classroom management
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What kind of treatment?

1.
2.
3.
4.
Early intervention program (EIP) Middle childhood intervention program (MCIP) Adolescent intervention program (AIP) Young Adult intervention program (YAIP)
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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, epilepsy 3. 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 test 8. Behavioral and emotional problem 9. Academic ability and placement (WRAT)
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Early Intervention Program

3. Rehabilitation 1. Sensory motor integration program 2. Speech therapy 4. Academic placement and support 1. Send them early (3-4 years old) to play school which has sensory motor developmental program and trained/empathic teacher 2. Special educational placement- private, NGO or public is recommended if the child has learning disability 3. Communicate with the school about the childs developmental problem and establish teacher support program
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Early Intervention Program

5. Home management 8 steps to Better Behavior 1. Learn to pay positive attention to your child 2. Use your powerful attention to gain compliance 3. Give more effective commands 4. Teach your child not to interrupt your activities 5. Set up a home token system 6. Learn to punish misbehavior constructively 7. Expand your use of time out 8. Learn to manage your child in public places
Middle Childhood Intervention Program

1.
Aims
1.
2.
3.
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
21

2.
Treatment approaches
1.
Psychological therapies
1. 2. 3. 4. 5. 6. 7.
Behavior/Cognitive behavior therapy Focus therapy Play therapy Art therapy Relaxation therapy Anger management Social group therapy
22

3. 4. 5. Pharmacotherapy
3.
Stimulant, non stimulant monitoring and maintenance For child with delay maturity 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
Rehabilitation program
3.
Academic placement and support

3.
4. 5.
6.
7.
Adolescent Intervention Program

1.
Aims
1.
2.
3.
To improve attention, behavior, mood and learning To help develop further the childs psychological and social maturity To provide parental guidance and family therapy
24

2. Assessment
2. 3. 4. 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 Individual psychotherapy Group therapy Anger management Relaxation therapy Family therapy/guidance
3.
Psychological therapies
2. 3. 4. 5. 6.
25

4.
Pharmacotherapy
1. 2. 3.
5.
Academic placement and support

1. 2. 3.
Stimulants, non stimulants Monitoring, dose adjustment and maintenance Consider tailing dose if the child reach the maturity to cope on his/her own
Monitoring of academic progress Reassess the childs psychological development and learning aptitude Assess the child potential for future vocation
Young Adult Intervention Program

1.
Aims
1. 2. 3. 4. 5.
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
27
Young Adult Intervention Program

2. Assessment 3. Psychological therapies
2. 3. 4. 5. 6. Cognitive behavior therapy Supportive psychotherapy Relaxation therapy Individual psychotherapy EEG biofeedback therapy
4. Medications 5. Academic placement and support
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Who can treat ADHD?
Specialist with expertise in ADHD
Child and adolescent psychiatrist Psychiatrist Clinical psychologist
29
Effective Treatment of ADHD
Multidiscipline
Medical Psychological Educational Rehabilitation
30
Medical Treatment
Medication is used to treat the symptoms and help the child with ADHD function more effectively Examples are
Ritalin, Stratera and Concerta
31
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
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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
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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
THE TEAM
Parents Family School officials Health care professionals
35
GIMC Child Developmental Team

1.
2.
3.
4.
Consultant Child and Adolescent Psychiatrist Clinical Psychologists Occupational Therapists Speech Therapists
36

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OVERVIEW OF ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)

Dr. Nor Hamidah Mohd Salleh Consultant Psychiatrist M.D.,M.Med.(Psy)

Attention span Impulse control Activity level

1. PREDOMINANTLY HYPERACTIVE IMPULSIVE TYPE

2. PREDOMINANTLY INATTENTIVE TYPE

A child must have six or more symptoms of hyperactivity/impulsivity

A child must display six or more symptoms of inattention

WHATS WRONG WITH ADHD CHILDREN

ADHD Diagnostic Evaluation

ADHD Diagnostic Evaluation

Why we need to treat ADHD?

When to start treatment?

What to expect in treatment of ADHD?

Pharmacotherapy Behavior therapy/cognitive behavior therapy Family therapy/guidance

Home management Parenting and stress management

What kind of treatment?

Early intervention program

Early Intervention Program

Early Intervention Program

Middle Childhood Intervention Program

Middle Childhood Intervention Program

Middle Childhood Intervention Program

Academic placement and support

Adolescent Intervention Program

Adolescent Intervention Program

Adolescent Intervention Program

Academic placement and support

Young Adult Intervention Program

Young Adult Intervention Program

4. Medications 5. Academic placement and support

Who can treat ADHD?

Specialist with expertise in ADHD

Child and adolescent psychiatrist Psychiatrist Clinical psychologist

Effective Treatment of ADHD

Medical Psychological Educational Rehabilitation

Ritalin, Stratera and Concerta

Documented Specific Beneficial Effects of Stimulants

Documented Specific Beneficial Effects of Stimulants

II. SOCIAL EFFECTS

Documented Specific Beneficial Effects of Stimulants

Parents Family School officials Health care professionals

GIMC Child Developmental Team

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