Attention Deficit Hyperactivity Disorder (ADHD)

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Attention deficit hyperactivity disorder is a lifelong neurodevelopmental disorder that affects the brain and results in a variety of inappropriate and maladaptive behaviors. ADHD is not a disease (Kajander 1995) but is a processing deficit that results in children having difficulty with inhibitory control. That is, children with ADHD lack self-control, something they cannot help. In children with ADHD, the parts of the brain that control attention and stop inappropriate behavior are underdeveloped (Barkley 1996; Kajander 1995). ADHD occurs three times more frequently in male students than female students (Reeve et al. 1995) and commonly occurs with other disorders. For example, ADHD occurs in 20 percent to 50 percent of the students with learning disabilities, in 65 percent of the students with oppositional defiant disorder, and in 20 percent to 30 percent of the students with conduct disorder (Reeve et al. 1995; Barkley 1990).

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  • What is Attention Deficit Hyperactivity Disorder? Attention Deficit Hyperactivity Disorder is the most commonly diagnosed behavioural disorder of childhood. In any six-month period, ADHD affects an estimated 4 -6 % of young people between the ages of 9 and 17. Boys are two to three times more likely then girls to develop ADHD. Although ADHD is usually associated with children, the disorder can persist into adulthood. Children and adults with ADHD are easily distracted by sights and sounds and other features of their environment, cannot concentrate for long periods of time, are restless and impulsive, or have a tendency to daydream and be slow to complete tasks Symptoms The three predominant symptoms of ADHD are 1) inability to regulate activity level (hyperactivity); 2) inability to attend to tasks (inattention); and 3) impulsivity, or inability to inhibit behaviour. Common symptoms include varying degrees of the following: Poor concentration and brief attention span Increased activity - always on the go Impulsive - doesn't stop to think Social and relationship problems Fearless and takes undue risks Poor coordination Sleep problems Normal or high intelligence but under perform at school For useful information about ADHD refer to the following website: http://www.psychiatry24x7.com/homes/adhd.jhtml
  • What is Attention Deficit Hyperactivity Disorder? Attention Deficit Hyperactivity Disorder is the most commonly diagnosed behavioural disorder of childhood. In any six-month period, ADHD affects an estimated 4 -6 % of young people between the ages of 9 and 17. Boys are two to three times more likely then girls to develop ADHD. Although ADHD is usually associated with children, the disorder can persist into adulthood. Children and adults with ADHD are easily distracted by sights and sounds and other features of their environment, cannot concentrate for long periods of time, are restless and impulsive, or have a tendency to daydream and be slow to complete tasks Symptoms The three predominant symptoms of ADHD are 1) inability to regulate activity level (hyperactivity); 2) inability to attend to tasks (inattention); and 3) impulsivity, or inability to inhibit behaviour. Common symptoms include varying degrees of the following: Poor concentration and brief attention span Increased activity - always on the go Impulsive - doesn't stop to think Social and relationship problems Fearless and takes undue risks Poor coordination Sleep problems Normal or high intelligence but under perform at school For useful information about ADHD refer to the following website: http://www.psychiatry24x7.com/homes/adhd.jhtml
  • Attention Deficit Hyperactivity Disorder (ADHD)

    1. 1. Meet a few accomplished people who have ADHD: Ozzy Osbourne
    2. 2. Albert Einstein
    3. 3. Whoopi Goldberg
    4. 4. Winston Churchill
    5. 5. Walt Disney
    6. 6. Understanding ADHD
    7. 7. History of ADHD Mid-1800s: Minimal Brain Damage Mid 1900s: Minimal Brain Dysfunction 1960s: Hyperkinesia 1980: Attention-Deficit Disorder With or Without Hyperactivity 1987: Attention Deficit Hyperactivity Disorder 1994-present: ADHD Primarily Inattentive Primarily Hyperactive Combined Type
    8. 8. What is Attention Deficit Hyperactivity Disorder? The condition often becomes apparent when children are in preschool or when they are in their early school years. An estimated 3-5% of children have ADHD.
    9. 9. ADHD Statistics 3-5% of all U.S. school-age children are estimated to have this disorder. 5-10% of the entire U.S. population Males are 3 to 6 times more likely to have ADHD than are females. At least 50% of ADHD sufferers have another diagnosable mental disorder.
    10. 10. Attention Deficit Hyperactivity Disorder (ADHD)   Onsets before age seven The main symptoms are: INATTENTION - HYPERACTIVITY IMPULSIVITY.  
    11. 11. Diagnosing ADHD:  DSM-IV  Inattentiveness: Has a minimum of 6  symptoms regularly for  the past six months. Symptoms are present at  abnormal levels for stage  of development Lacks attention to detail;  makes careless mistakes has difficulty sustaining  attention doesn’t seem to listen fails to follow through/fails  to finish projects has difficulty organizing  tasks avoids tasks requiring  mental effort often loses items necessary  for completing a task easily distracted  is forgetful in daily activities
    12. 12. Diagnosing ADHD:  DSM-IV Hyperactivity/ Impulsivity: Fidgets or squirms  excessively leaves seat when  inappropriate runs about/climbs  extensively when  inappropriate has difficulty playing  quietly often “on the go” or “driven  by a motor” talks excessively blurts out answers before  question is finished cannot await turn interrupts or intrudes on  others Has a minimum of 6  symptoms regularly for the  past six months. Symptoms are present at  abnormal levels for stage of  development
    13. 13. Diagnosing ADHD:  DSM-IV Additional Criteria: Symptoms causing impairment  present before age 7 Impairment from symptoms  occurs in two or more settings Clear evidence of significant  impairment (social, academic,  etc.) Symptoms not better accounted  for by another mental disorder
    14. 14. It is VERY important that children are  examined and diagnosed by a qualified  professional who will use strict diagnostic  guidelines to determine whether the  behaviors are inappropriate for the child’s  age, and whether the symptoms indicate  ADHD or not.  Talking to your family physician might  be a good start. ADHD: Getting a diagnosis
    15. 15. Learning  Disabilities About 20-30% of children with ADHD also have a specific  LD. It is a good idea to have your child with ADHD  assessed for a learning disability. Several disorders can accompany ADHD. See your family doctor or  specialist if you suspect your child has any of these disorders. Tourette  Syndrome A small proportion of children with ADHD also have this  neurological disorder, which can be controlled with  medication. Symptoms include nervous tics and repetitive  mannerisms. Bipolar  Disorder Some children with ADHD also have BD. Differentiating  between ADHD and BD in childhood can be difficult, however,  as some symptoms are present in both disorders.  ADHD: Accompanying disorders
    16. 16. Several disorders can accompany ADHD. See your family doctor or  specialist if you suspect your child has any of these disorders. Oppositional  Defiant Disorder As many as 1/3 to 1/2 of children with ADHD also have  ODD. Children with ODD are defiant, non-compliant,  belligerent, and stubborn.  Conduct  Disorder About 20-40% of children with ADHD will develop  CD, which is a more serious pattern of antisocial  behavior. Children with CD are aggressive and  destructive, and are at great risk of getting into trouble  at school or with the police.  Anxiety &  Depression If co-occurring anxiety or depression is recognized and  treated, children will be better able to handle the  problems that accompany ADHD.  ADHD: Accompanying disorders
    17. 17. BUT… some studies have shown a relationship  between alcohol and tobacco use during pregnancy and  the risk for ADHD in the baby.  So, these activities should be  avoided while pregnant! What causes ADHD?
    18. 18. The cause of ADHD remains unknown, but  most research suggests that the cause lies in  neurobiology (some parts of the brain are  smaller in children with ADHD) or genetics  (ADHD tends to run in families, so there are  likely genetic influences).  Although environmental and social factors  (like child-rearing style) can influence the  severity of the disorder, they do not cause  the disorder.  What causes ADHD?
    19. 19. Several teams of researcher have found relatively consistent abnormalities in five areas of the brain in people with ADHD: Prefrontal Lobes Frontal Lobes Basal Ganglia Cerebellum Corpus Callosum
    20. 20. 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. Armstrong (2010)
    21. 21. The prefrontal cortex is one of the last areas of the brain to fully mature. In patients with ADHD it is hypothesized that they mature at a slower rate than their peers without ADHD, sometimes between two and three years slower. However it must be said that children with ADHD do undergo normal patterns of brain development they just lag behind their peers. Armstrong (2010)
    22. 22. Basal Ganglia also helps with movement and motor control. Dopamine, either too much or too little affects how the Basal Ganglia communicates to the rest of the brain. Sweeney (2009), Armstrong (2010)
    23. 23. The Cerebellum is responsible for producing coordinated muscle movements. It also works to sequence thoughts of motion. Sweeney (2010), Armstrong (2010)
    24. 24. ADHD is not caused by: Will Power Inadequate Parenting Lack of Motivation Lack of Intelligence Laziness
    25. 25.  Medical Examination  Clinical Interview  Teacher and Parent Rating Scales  Behavioral Observations Four Components in Assessing whether a student has ADHD
    26. 26. Psychological and Behavioral Characteristics: Behavioral Inhibition (Russell Barkley)  involves the ability to: 1. Delay a response 2. Interrupt an ongoing response 3. Protect a response from distracting or competing stimuli (Lawrence et al., 2002) People with ADHD frequently delayed inner speech Children and adults with ADHD have problems controlling their emotions and their arousal levels. Children and adults with ADHD have difficulty analyzing problems and communicating solution to others.
    27. 27. Educational Considerations Classroom structure and teacher direction Functional behavioral assessment  involves determining the consequences, antecedents, and setting events that maintain inappropriate behaviors (Horner & Carr, 1997) Contingency-based self-management  involve having people keep track of their own behavior and then receive consequences, usually in the form of rewards, based on their behavior (Davies & Witte, 2000; DuPaul, Arbolino, & Booster, 2009; Shapiro, DuPaul, & Bradley- Klug, 1998).
    28. 28. Stimulants (like methylphenidate or “Ritalin”) seem to be the most effective class of medication, and are usually considered quite safe. They do not make children feel “high” and there is no evidence that stimulants (when used for the treatment of ADHD) cause drug abuse or dependence. Medications have been used to treat ADHD for decades. Treatment for ADHD
    29. 29. In many people, stimulants reduce hyperactivity and impulsivity, and improve the ability to focus, work and learn. About 10% of children are not helped by stimulants, even after trying several medications at several doses. Recently, at least one non-stimulant medication has shown great potential for reducing the symptoms of ADHD (atomoxetine or “Strattera”). Treatment for ADHD
    30. 30. Choosing a Treatment for ADHD What does the research show? Medication seems to be essential for children with ADHD. The most intensive ADHD treatment study to date found that long-term management with medication or a combination treatment of medication and behavioral treatment are superior to behavioral treatments alone.
    31. 31. Which treatment will be most effective for my child? Because no two children are alike, this question must be answered by each family in consultation with their health care professional.
    32. 32. Although medication works well for many children, it can cause undesirable side effects in others, making it an unacceptable treatment. Each child’s needs and personal history must be carefully considered. BUT… no one treatment is the answer for every child!
    33. 33. If you need more help.. Medication can help a child control the behavior problems that have led to trouble with parents and siblings, but it can take a long time to undo the frustration, blame and anger that may have gone on for so long. ADHD: What else can we do?
    34. 34. Children AND parents might need special help to develop techniques for managing the patterns of behaviour. Many intervention approaches are available, including: psychotherapy, behavioral therapy, social skills training, support groups and parenting skills training.
    35. 35. Try these simple tips…! (1) Schedule - have the same routine every day, and post the schedule in the kitchen. (2) Organize needed everyday items - have a place for everything, and keep everything in its place. (3) Use homework/notebook organizers - stress the importance of writing down assignments and bringing home needed books. ADHD: What else can we do?

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