ADHD

1. Presenting by :
Madiha Saher
PMDCP I
UoH
Attention Deficit Hyperactivity
Disorder (ADHD)

2. What Is ADHD?

7. Aetiology
Heritability is the strongest factor in development
of ADHD
Risk factors account for only a small portion of
variance
Pregnancy variables: young maternal age,
maternal use of tobacco and alcohol, toxaemia,
post-maturity and extended labour
Medical factors: fragile X syndrome, G6PD
deficiency, phenylketonuria, brain trauma, lead
poisoning, malnutrition

9. begins in childhood and can affect all areas of a patient’s life.
3% - 5% of school-aged children-2 million children in the US (National
Institute of Mental Health (NIMH))
Boys outnumber girls 3 to 1 (Mental Health America) However, girls
may be under diagnosed.
Prevalence

10. Adult ADHD largely remains
Undiagnosed

11. Predominantly inattentive (ADHD/I)
Predominantly hyperactive/impulsive ADHD (ADHD/HI)
Combined ADHD
Three Major Types

12. difficulty paying attention
struggles to concentrate and complete tasks forgetful and easily
distracted
poor organizational skills, lethargic, sluggish, shy, anxious or
constantly daydreaming
most often diagnosed in adolescent girls, and is diagnosed if six or
more symptoms of inattention have persisted for more than six
months, according to the American Psychiatric Association (APA).
Predominantly inattentive
(ADHD/I)

13. Combines symptoms of the other two forms of ADHD
the most common form of ADHD.
diagnosed in boys of elementary-school age.
diagnosed when six or more symptoms associated with each of the two
major forms of ADHD are present.
Combined ADHD

14. difficulty controlling behavior, with an increased
risk for serious aggressive or oppositional behavior
and antisocial conduct.
fidget and excessively restless.
blurt out comments that are inappropriate and often do not think before
they act.
diagnosed if six or more symptoms of hyperactivity and impulsivity have
persisted for more than six months.
Predominantly hyperactive/impulsive
ADHD (ADHD/HI)

16. Creativity
Flexibility
Enthusiasm and spontaneity
Energy and drive
Positive Traits

17. DSM -V

18. DSM-IV-TR DSM-5
Attention-Deficit/Hyperactivity
Disorder
Attention-Deficit/Hyperactivity
Disorder
• Inattention (6/9)
• Hyperactivity-impulsivity (6/9)
• Inattention (6/9)
• Hyperactivity and impulsivity
(6/9)
• Age of onset: before age 7 • Age of onset: before age 12
• Symptoms described so as to
better able to diagnose adolescents
and adults
a
Classified as a disorder Usually First Diagnosed in Infancy, Childhood, or
Adolescence
ADHD in DSM IV & V

19. Other DSM criteria

20. ADHD and the
Brain

22. ADHD is now believed to be a Neurological
Disorders ( Brain Based) which can be genetic yet
the specific cause is still unclear. What we do
know is there is a lack of:
* Regulation of Attention
* Regulation of Motor Activity
* Regulation of Impulsivity.

23. The thought is that there are several areas of the
brain that may be affected by ADHD. Some of
these areas are:
Frontal Lobes/Prefrontal Cortex
Limbic System
Basal Ganglia

24. The Frontal Lobe/Prefrontal
Cortex helps us to:
Focus Concentration
Pay Attention to our tasks
Make good decisions
Plan Ahead
Learn and to remember what
we have learned.
To have proper behavior in
situations where it is required.

28. There are chemical
differences in the brains of
people with ADHD.
These chemicals are:
Dopamine
Nor epinephrine
New Research is also
suggesting:
Glutamate

31. How can We help people with ADHD ?

32. Assessment
History – parents or caregivers,
− as well as a classroom teacher or other school
professional
Interview of child
Parent and teacher ratings of ADHD-related
behaviours
Investigations - No clinical examination or lab
tests are accepted as either “rule in” or “rule out.”
Recommend vision & hearing tested

33. Assessment
RATING SCALES
- Not diagnostic – screening test
- Monitor response to interventions
PSYCHOMETRICS
- WISC/WIAT
- CPT
- TEA-Ch
Others as indicated
- Speech & language
Occupational therapy
Auditory processing

35. Differential Diagnosis
Hearing Loss
Auditory processing
Learning Disability
Epilepsy
CNS abnormality
Metabolic
Tourette’s syndrome
Tics
Sleep apnoea
Lead poisoning
Hyperthyroidism
Pin worms
Autism

36. Differential Diagnosis
Emotional distress
PTSD
Oppositional Defiant
Disorder
Conduct Disorder
Bipolar Disorder
Anxiety Disorder
Substance Abuse
Depression

37. “Child abuse victims are at
increased risk of a variety of child
and adolescent psychiatric
diagnoses, including depression,
anxiety, conduct disorders, OCD,
ADHD and substance abuse.”
Kaplan et al Oct 1999

41. Psychological
Psychiatric Educational
Other
individually
determined
strategies
MedicalDietary
Coaching
Behavioural &
parent training
programmes
Multidisciplinary
Treatment of ADHD
Substance
abuse

42. Non-Pharmacological Management
• Family Therapy may be required for reasons such as: difficulty raising &
managing a child with ADHD and new roles for individuals within the family.
• ADHD in parents may impact success of parent training and family therapy

43. Non-Pharmacological Management
Diet
Elimination diets – difficult
Omega 3 – at least 1000mg/day for a month
Academic skills training: focus on following
directions, becoming organized, using time
effectively, checking work, taking notes

44. Non-Pharmacological Management
Behavioural therapy
- Does not reduce symptoms
• May improve social skills and compliance
• Does not lead to maintenance of gains or improvement over time after the therapy is
completed
Social skills group
- Uses modelling, practice, feedback and contingent reinforcement to address the social
deficits common in children with ADHD
- Useful for the secondary effects of ADHD, such as low self-esteem, but not helpful for
core symptoms of ADHD

45. MEDICATIONS FOR ADHD
Stimulant Medications
Methylphenidate (Ritalin, Ritalin LA, Concerta)
Dexamphetamine
Non-stimulant
Atomoxetine (Strattera)
Other
Clonidine (Catapres)
Risperidone (Risperdal)

46. MEDICATIONS FOR ADHD
Tricyclic Antidepressants
•Desipramine ;Imipramine (Tofranil)
Other Antidepressants
•Bupropion (Zyban); Fluoxetine (Prozac)

47. Stimulants Specific Effects
Improved sustained attention
Reduced distractibility
Improved short-term memory
Reduced impulsivity
Reduced motor activity
Decreased excessive talking
Reduced bossiness and aggression with
peers

48. Stimulants Specific Effects
Increased amount & accuracy of academic work completed
Decreased disruptive behaviour
Improved handwriting and fine motor control
Reduced off-task behaviour in classroom
Improved ability to work and play independently as many as 75% of kids on these
medications show improvement
also seems to cause improvement in kids without ADHD in terms of attention and
classroom behaviour

49. SIDE EFFECTS OF STIMULANTS
Insomnia
Decreased Appetite (in 50-60%) =>Weight Loss
1-2 cm shorter by end of growth
Headaches
Stomach aches (20-40%)
Mood liability/ dysphoria
Prone to Crying (10%) ‘sensitive’

50. SIDE EFFECTS OF STIMULANTS
Nervous Mannerisms (10%)
Over focused behaviour; Cognitive toxicity
(Mild) Increases in Heart Rate and Blood Pressure
- NO INCREASE IN SUDDEN DEATH

51. How Teacher can help

52. Be consistent.
Set a good example.
Anticipate and avoid problems.
Praise good behavior.
Negotiate and consult with your child.
Pick your battles.
Believe in and support your child.
Keep things in perspective.
Pay attention to the siblings.
Take of yourself.
Communicate
Connect
Tips for Parents

53. Conclusion :

54. ADHD Myths Busted
As published on ADDitude Magazine’s website,
these are the most common ADHD myths:
• #7: People with ADHD are stupid and lazy.
• #6: ADHD children on medication will abuse drugs as
teenagers.
• #5: ADHD is the result of bad parenting.
• #4: ADHD affects only boys.
• #3: Children with ADHD often outgrow the condition.
• #2: Children given ADHD accommodations are given an
unfair advantage.
• #1: ADHD is not a real medical disorder.

55. Meet a few accomplished people who
have ADHD:
•21st Century Leaders
•Children in Need
•Elton John AIDS
Foundation
•Los Angeles Youth
Network
•MusiCares
•Music for Relief
•Prince's Trust
•Rock the Earth
•Save the Children
•Sharon Osborne Colon
Cancer Program
•Small Steps Project
•Starkey Hearing
Foundation
•Whatever It Takes
•World Vision
Ozzy Osbourne

56. Albert Einstein

57. Whoopi Goldberg
American comedian,
actress, political activist,
writer, producer, television
host and singer

58. Winston Churchill

59. Walt Disney
American motion-picture and television
producer and showman, famous as a
pioneer of cartoon films and as the creator
of Disneyland.
Walter Elias "