ADHD_session_one

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This presentation provides an understanding about the fundamentals of Attention Deficit Hyperactivity Disorder (ADHD) in the human lifespan.

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  • (Slide 1) Hi! Welcome to “Be Aware & Be There” - reach and teach children with ADHD. I am Cindy Yew, the trainer for this professional development course which will be conducted over a span of two sessions.
  • (Slide 2) For the first session, we shall focus on “Be Aware” of children with ADHD by gaining knowledge and understanding about the topic of ADHD. The second session shall focus on “Be There” so you can be equipped to teach children with ADHD.
  • (Slide 3) Have you always heard about the term ‘ADHD’ yet its meaning remains unfamiliar to you? Let’s spend 5 minutes on doing a pre-evaluation assessment tool to see how much you know about ADHD. Please retrieve the Assessment Tool from your Learner’s guide (file). Please submit them into the “collection basket” once you are done. They will be returned to you at the end of the day with further instructions. (Trainer collects back the assessment tool forms from learners before progressing to the next slide).
  • (Slide 4) (Pre-video viewing) In this first session, we shall delve into the definition of ADHD; the underlying causes; the prevalence and incidence; the characteristics; the diagnosis and subtypes of ADHD, and some current issues and data on research about ADHD in the world, U.S., and Singapore. These will be expounded and covered in a brief within this 1 hour and 30 mins session. We will watch a video on “ADHD and the Brain” to begin the session. Before we do so, I would like you to jot some notes and questions while watching the video. The questions can pertain to any of the areas I just mentioned we will be covering too. Let’s watch this video for a quick overview about ADHD. (Post-video viewing) Dr Gerald Shonak gave a succint overview about the relationship between ADHD and the brain. I hope you have jot down the questions while watching the video. As we go along this first session, do take time to reflect on the areas we are about to cover and if they answer your questions. If they have not been covered, there will be a Q& A at the end of the session where you may raise your questions. Do note that you are free to raise any pressing questions while we are at any topic throughout the session too. Let ’s begin!
  • (Slide 5) What is ADHD? ADHD is Attention-Deficit/Hyperactivity Disorder (ADHD). It is also known as Attention Deficit Disorder (ADD). ADHD is one of the most prevalent neurodevelopmental/mental health conditions in childhood. (Batshaw, Pellegrino, & Roizen, 2009, p. 345). It is a neurobehavioral disorder that typically begins at childhood and often persists into adulthood. Therefore it is important to know and understand the implications for the individual, as well as his or her family and community. (Harpin, 2005; Klassen, Miller, & Fine, 2004 as cited in Batshaw, Pellegrino, & Roizen, 2009, p. 345)
  • (Slide 6) Research has shown that ADHD is caused by neurochemical imbalance in the brain which affects several areas of the brain, mainly the frontal cortex as shown in the earlier video “ADHD and the brain”. The underlying causes can be genetic (hereditary) and/or environmentally (non hereditary). When the underlying cause is genetic/hereditary, it appears to run in the family. According to the incidence of ADHD, siblings of children with ADHD are between 5 to 7 times more likely to be diagnosed with ADHD than children in unaffected families. Each child of a parent with ADHD has a 25% chance of having ADHD; and between 55% and 92% of identical twins both are likely to have ADHD too (Reviewed in Faraone, Perlis, et al., 2005; Batshaw, 2009, p.349). Studies have also shown that 30% to 60% of individuals diagnosed with ADHD will continue to demonstrate symptoms in adulthood. (Batshaw, Pellegrino, & Roizen, 2009, p. 345) When the underlying cause is environmental/non hereditary, it refers to exposure to toxins such as lead/smoking/alcohol/drugs; complications during pregnancy such as oxygen deprivation; premature birth such as low birth rate, weighing not more than 1500g or 3.3 pounds; and injury to the brain from trauma, low omega-3 essential fatty acids; brain tumors, and strokes or disease. (Source: www.myadhd.com )
  • (Slide 7) What does ADHD look like? Can you identify when you see it? Read this cartoon. Given the comprehensive information required before a child is proven to have ADHD, the medical assessment should be conducted by a primary person responsible for formulating the diagnosis and communicating the findings and recommendations to the child ’s family. He or she should also be experienced with the range of coexisting conditions, for instance, pediatrician, neurodevelopmental or behavioral pediatrician, neurologist, psychiatrist or psychologist. Teachers are not at liberty to determine or conclude that a child is proven to have ADHD; though your acute observations of the characteristics of ADHD displayed by any child will help address and progress the needs of the child. Hence, knowing the characteristics of ADHD will help you better identify children with ADHD in your class/school and support parents who have children with ADHD.
  • (Slide 8) ADHD is a neurobehavioural syndrome. Currently, diagnosis is dependent on ruling the symptoms of ADHD and ruling out symptoms of ADHD as there are no available medical or psychological test to make the diagnosis. Diagnosis is conducted through the use of interviews and rating scales to systematically collect data from parents, teachers, and (older) children. The clinician must evaluate whether (1) significant ADHD symptoms exist in more than 1 setting (2) these symptoms result in functional impairment (3) these symptoms are the result of another psychiatric, medical, or social conditions With all these being said, the diagnostic criteria of ADHD to identify children displaying the symptoms consists of two major clusters of symptoms: mainly, inattention/distractibility and hyperactivity/impulsivity. (APA, 2000)
  • (Slide 9) What do we mean by ruling the symptoms and ruling out the symptoms? We shall take a closer look into the symptoms for each criteria. Inattention/distractibility has 9 symptoms; while hyperactivity/impulsitivity has 9 symptoms too according to the Diagnostic Criteria for ADHD (Batshaw, Pellegrino, & Roizen, 2009, p. 346-347) To make a diagnosis, A. At least 6 symptoms from just Category A (ADHD, Inattentive Subtypes), or just Category B (ADHD, Hyperactive-Impulsive Subtype), or at least 6 symptoms from both categories (ADHD, Combined Subtype) B. Symptoms are chronic (some symptoms were functionally impairing from before the age of 7) C. Symptoms do not occur exclusively during the course of...another mental disorder.
  • (Slide 10) There are 4 subtypes of ADHD. ADHD C where C refers to combined type; I - inattentive; HI - impulsive/hyperactive; and NOS - not otherwise specified. Children diagnosed with ADHD combined type (ADHD-C) predominately display at least six or more from both symptom clusters. Symptoms must be evident before age 7; have persisted for not less than 6 months; occur across different settings; cause impairment; and cannot be better accounted for by another disorder. Children in this subtype has fewer disruptive behaviour disorders. Children who have ADHD-I do not display significant levels of hyperactivity but have problems maintain attention. He/she is distinctly characterised by a “slow” cognitive tempo. Children with ADHD-HI do not display significant levels of attention problems in the presence of hyperactivity and impulsivity. Children with ADHD-NOS meet the symptoms of ADHD but does not meet the criteria for the diagnosis which can be due to age.
  • (Slide 11) Activity - Goo Time! Duration: 10 minutes discussion; 10 minutes to check if groups answered correctly. Question: Which types of ADHD do these symptoms belong to? Instruction(s): In pairs, discuss and fix the puzzle by matching the symptoms to the headers according to the types. Materials for discussion: - An envelope containing cut-out strips stating one symptom each; and the four types of ADHD as header. - blue tac - an A3 paper as a base for piecing the puzzle together
  • (Slide 12) It is imperative for teachers to bear the four types of ADHD given the increasing prevalence of ADHD. The prevalence of ADHD can be addressed in four areas: (Batshaw, 2009) First is prevalence by subtypes (Batshaw, 2009, p. 346-347). The ratio of girls to boys for ADHD predominately inattentive type (ADHD-I) is slightly higher than for other subtypes, and is usually identified at a later age. Whereas, ADHD-predominately impulsive/hyperactive type (ADHD-HI) is more prevalent in young children who have not yet reached an age at which attention problems are impairing. Second is prevalence by clinical presentation (Batshaw, 2009, p. 347). Excessive activity and impulsive activity are typically present in preschool years, where it is also accompanied by “intense” temperament and cognitive inflexibility. During the elementary years, issues are predominately with listening, compliance, task completion, work accuracy. The adolescent will exhibit diminishing ability to cope as their attentional/executive systems are overwhelmed by the demands for processing increased volumes of reading and writing; including the complex social, time management, organizational, and higher-order thinking and language processing skills required of them (Stein & Baren, 2003 cited in Batshaw, 2009). The next prevalence is by coexisting/comorbid conditions (Batshaw, 2009, p. 348). Approximately 30% to 50% have externalizing behavior disorder such as oppositional defiant disorder or conduct disorder. 14% to 83% have estimates of mood disorder and as many as 10% have childhood bipolar; 10% to 40% have learning disorders and 6% have Tic disorders. The last prevalence is with associated impairments (Batshaw, 2009, p. 349). Children belonging to this prevalence have a high rate of pragmatic language difficulties. They also have an increased incidences of issues with motor coordination that may impair written work and participation in athletic activities.
  • (Slide 13) A research conducted by National Institute of Mental Health (NIMH) in U.S. on ADHD among children showed lifetime prevalence of mental disorders in U.S. adolescents. Results of the study found 9% of 13 to 18 year olds; 12.9% of males; and 4.9% of females with lifetime prevalence of mental disorders.
  • (Slide 14) I do not meant for you to read the wordings on this slide but to show that another study conducted showed an increasing prevalence of parent-reported ADHD among children in U.S. between 2003 and 2007. Out of a numerous past studies done on the topic, a 2003 survey found an estimated 7.8% of children aged 4 to 17 years to have been diagnosed with ADHD. Over the years from 2003 to 2007, the prevalence of parent-reported ADHD among children aged 4 to 17 years has increased 21.8% (from 7.8% to 9.5%); and the increase was 42% among older adolescence. Overall, in United States, approximately 1 million more children were reported with ADHD in 2007 than in 2003. The findings in this study raised an alarming fact that nearly one in 10 children aged 4 to 17 years are diagnosed with ADHD by 2007, which shows a substantial increase of 8.4% of children aged 6 to 17 years in the recent estimation based on annual data from the 2004 to 2006 National Health Interview Survey (NHIS). These alarming facts serve as “red alert” for teachers and health practitioners to be aware of the importance of gaining better knowledge about ADHD; so we can collaborate with parents; and knowing the fundamentals to reach and teach the children with ADHD in our classrooms. Source: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5944a3.htm?s_cid=mm5944a3_w Flag source: http://t2.gstatic.com/images?q=tbn:ANd9GcQTbzetYXGdiOk1hppEEOpOOkBq_DP NxTDPlulfawN0Grw9mlpt
  • (Slide 15) Let ’s move the topic closer to our heart! Singapore! A commentary “Attention Deficit Hyperactivity Disorder: Coping or Curing?” by Dr Daniel Fung and Tih Shih Lee, Department of Child and Adolescent Psychiatry, Institute of Mental Health revealed that a recent meta-analysis has shown an estimated worldwide prevalence of ADHD to be 5.29% (researched by Duke-NUS Graduate Medical School, Singapore). The findings in a survey of 2400 children aged 6 to 12 years in Singapore showed that 4.9% had disruptive behavior disorders by parent ratings (researched by School of Humanities and Social Science, NTU, Singapore). It also revealed that a burden of disease study conducted by the Ministry of Health (MOH), Singapore had placed ADHD as the third largest contributor of Disability Adjusted Daily Years (DALYs) in age group 10 to 16 years. As research has shown that ADHD is neurodevelopmental disorder, this burden of disease is likely to persist into adulthood, though this remains a controversial issue faced by the doctors today. So, do we cope with ADHD or can ADHD be cured?
  • (Slide 16) Activity - Goo Time! Duration: 20 minutes discussion; 10 minutes presentation Question: “ Do we cope with ADHD or cure ADHD? ” Instruction(s): In a group of four to five, discuss your thought about the above question. Search websites for resources which may help support your views. Do a quick search on the possible avenues/websites. In 5 minutes, have your group to share about your thoughts and findings. Materials given for discussion: Fung, Daniel & Lee, Tih Shih. (2009). Attention Deficit Hyperactivity Disorder: coping or curing?. Annals of the Academy of Medicine, Singapore, 38. Retrieved from http://www.biomedsearch.com/nih/Attention-Deficit-Hyperactivity-Disorder-coping/19890587.html
  • (Slide 17) Q&A Trainer allows learners to ask questions for the sessions delivered.
  • The credits shown here are in addition to the acknowledgement of sources embedded in the individual slides.
  • ADHD_session_one

    1. 1. “Be Aware & Be There”Reach & Teach Children with Attention- Deficit/Hyperactivity Disorder (ADHD) Cindy Yew Trainer Session One 2012 Department of Professional Development Source: child-development-guide.com
    2. 2. “Be Aware & Be There”Reach & Teach Children with Attention- Deficit/Hyperactivity Disorder (ADHD) Cindy Yew Trainer Session One 2012 Department of Professional Development Source: child-development-guide.com
    3. 3. ...A D H D ? Spend 5 minutes.Do a pre-evaluation assessment tool to find out how much you know about ADHD. Source: chironeuroindy.com;
    4. 4. Source: youtube.com
    5. 5. ADHD is Attention-Deficit/Hyperactivity Disorder;also known as Attention Deficit Disorder (ADD) A neurobehavioral disorder that typically begins at childhood and often persists into adulthood. Source: t2.gstatic.com
    6. 6. Neurochemical imbalance in the brain causes inattentiveness, hyperactivity, and impulsitivity. Genetics /Hereditary Environmental /Non hereditarySource: scienceblogs.com
    7. 7. What does ADHD look like? Source: realfooduniversity.com
    8. 8. D ia g n o s is & S u b t y p e s o f ADHDNo currently availablemedical orpsychological test tocreate the diagnosisDiagnosis is dependenton ruling thesymptoms of ADHD Diagnostic criteria consistsand ruling out of two major clusters ofsymptoms of ADHD. symptoms: inattention/distractibility and hyperactivity/impulsivity.
    9. 9. At least 6 symptoms from just Category A(ADHD, Inattentive Subtypes) or just Category B (ADHD, Hyperactive- Impulsive Subtype) or from both categories(ADHD, Combined Subtype)
    10. 10. ADHD ADHDcombined inattentivetype type ADHD-C ADHD-I ADHD-HI ADHD-NOSADHD ADHDimpulsive/hyperacti -not otherwiseve type specified type
    11. 11. Goo Time! 10 minutes Discussion in pairs Q: Fix the puzzle“Where do these symptoms belong?”
    12. 12. Prevalence of ADHD by Subtypes Clinical presentation Coexisting/comorbid conditions Associated impairment
    13. 13. U.S.researchon ADHD amongchildren Source: nimh.nih.gov
    14. 14. Source: cdc.gov; t2.gstatic.com
    15. 15. Singapore research on ADHDamong children Ann Acad Med Singapore, 2009 OCt; 38 (10); 916-7 19890587 Attention Deficit Hyperactivity Disorder: coping or curing? Daniel Fung, MBBS, MMed (Psychiatry), FAMS; Tih Shih Lee, MD, PhD, FAMS Department of Child and Adolescent Psychiatry, Institute of Mental Health, Singapore
    16. 16. Goo Time! 20 minutes Discussion in a group of 4-5Q: “Do we cope with ADHD or cure ADHD?”
    17. 17. Source: reliablembc.com
    18. 18. CreditsSources:•Batshaw, M. K., Pellegrino, L., & Roizen, N. J. (2009). Children with disabilities. (6thed.).Baltimore, US: Paul H. Brookes Publishing Co.•ADHD and the Brain - http://youtu.be/u82nzTzL7To From Cindy Yew Thank you for your attention and participation. See you in the next session.

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