Assessment of ADHD

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Dr. Chavda's presentation at Tata Learning Disability Forum (TLDF), 2013.
The Forum for Learning Disabilities centred on the theme ‘Learning Disabilities – a more inclusive perspective’. The forum this year included in its purview three additional Learning Disabilities (LD), namely Specific Learning Disability (SpLD), Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD).

In line with the TATA Group’s corporate sustainability endeavors, TIS initiated the Tata Learning Disability Forum (TLDF) in 2006 to ensure that students with special education needs receive the required attention as well as to spread awareness about LD which had been receiving scant attention in India. Since then, via the TLDF platform, TIS has been successful in generating an increased level of awareness and enabling progress in remediation activities for students with LD.

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Assessment of ADHD

  1. 1. ASSESSMENT OF ADHD Dr. Kersi Chavda
  2. 2. FACT: ADHD is a clinical diagnosis with no specific validated biological or cognitive tests.
  3. 3. EVALUATION SHOULD IDEALLY INCLUDE Interview with parents to evaluate developmental, medical and family history, and assess family functioning Interview with child to assess physical disorder, co morbid mood disorder, tic disorder, anxiety disorder, substance use disorder or speech or language problems
  4. 4. NOTE THAT…Patients with ADHD, either youth or adult, tend to under report their ADHD symptoms, so collaborative history is helpful
  5. 5. CHECK OUT: Medical problems e.g. endocrinopathy, environmental exposure Neurological disorders e.g. petit mal epilepsy or complex partial seizures Collateral information from school, including school rating scales Specific Rating scales for parents and teachers
  6. 6. ASSESSMENT SCALES FOR ADHD DSM IV scales Connors Rating Scale –Revised These have demonstrated high sensitivity and specificity for differentiating between children with ADHD and aged-matched community controls
  7. 7. LAB TESTS: Lead levels(not common) Thyroid function tests Vit B12 levels Vit D3 levels Iron deficiency EEG Neuro –imaging Genetic testing
  8. 8. SPECIALIST CONSULTATION Us e the services of a Neuro-developmental Paediatrician , neurologist, psychiatrist, psychologist, Occupational Therapist Rarely hospitalize if the patient is a danger to himself or to another
  9. 9. D/D Thyroid disorders Foetal -alcohol syndrome PANDAS Autism and PDD Conduct Disorder Oppositional Defiant Disorder Depressive disorder/Bipolar disorder Substance use disorder
  10. 10. ONCE DIAGNOSIS OCCURS…. move towards treatment
  11. 11. Treatment of ADHD
  12. 12. FACT:The Multimodal Treatment Study for ADHD suggested that stimulant medication is a reasonable first-line treatment for most children with ADHD.However, concomitant psycho-socio-behavioural interventions are also indicated.
  13. 13. NON- DRUG THERAPYBehaviour Therapy: As an adjunct to drug therapy Alone as initial therapy in very young children or those with mild symptoms or if there is a disagreement about the diagnosis
  14. 14. ASPECTS OF BEHAVIOUR THERAPY Information and the natural history of the condition Learning to observe the childs appropriate and inappropriate behaviour more carefully Using a home “Token economy” system effectively…positive and negative reinforcements
  15. 15. ALSO How to use “Time out” effectively How to manage non-compliant behaviours in public Learning to avoid future behavioural catastrophes
  16. 16. YOU NEED TO take individual differences in co morbid mental health issues and behavioural problems, functional impairments and family issues ,into account while designing appropriate interventions
  17. 17. NOTE There is no evidence to support the use of CBT, Play Therapy or dietary modifications in the treatment of ADHD in children. However, there is evidence to support the use of CBT with drug therapy in the treatment of adults with ADHD.
  18. 18. TEACHERS ROLE Individualize intervention plans to meet the specific needs of the child Identify antecedents and consequences of their classroom behaviours Clearly state class-room rules Provide a structured learning environment Review the rules every day
  19. 19. IMPORTANT Give feedback to the student frequently Provide consistent consequences Provide positive feedback for good behavior and ignore mild inappropriate ones Preferential seating Divide longer assignments into smaller discrete pieces Use a token economy system
  20. 20. ALSO Use “Time-out” appropriately Consider interventions like use of a buddy/peer tutoring Use of concessions laid down by the various Boards of education
  21. 21. USE OF OCCUPATIONAL THERAPY This is known to benefit kids who have ADHD….done on a long term basis. It can be used individually or in a group situation
  22. 22. PHARMACOLOGICAL TREATMENTSConsider stimulants like Methylphenidate to be the first –line drug treatment Response rates estimated to be between 75 to 80%
  23. 23. OTHER MEDICATIONS Atomoxetine Buproprion TCAs Clonidine Anti-psychotics? Anti-epileptics?
  24. 24. SPECIFIC RECOMMENDATIONS: Explain ADHD to parents and their families Encourage patients to reach their individual treatment goals Explain the rationale of specific behavioural modifications Explain drug therapy>>>why? How long? Dosage? Side-effects
  25. 25. ALSO Read…but remember that Dr Google is not a doctor Join support groups or start them in your area Follow-up/ monitor patients regularly
  26. 26. HOWEVER…Pharmacological or psychotherapeutic treatment of co morbid psychiatric disorders may need to be initiated first if they are significantly impairing…e.g. mood disorders or tic disorders
  27. 27. Thank you

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