ADHD is a chronic neurodevelopmental disorder manifesting as inattention, hyperactivity, and impulsivity. It affects around 11% of school children in India. Core features include inattentiveness, hyperactivity, and impulsivity. ADHD can cause academic, social, and emotional impairments. Behavioral interventions are recommended initially, while medication may be needed along with or without behavioral therapies for school-aged children. Treatment aims to improve symptoms and functioning.

2. * Makes silly mistakes
* Needs constant supervision
* Doesn’t remember
* Loses things frequently

3. • Unable to sit at one
place in the class
• Very talkative loud
and noisy
• Clumsy & mischievous
• Can’t wait for his
turn while playing

4. • Accident prone
• Puts himself & others
in embarrassing
situations
• Ends up breaking
things without such
intensions

5. Attention-Deficit/
Hyperactivity
Disorder

6. ADHD is a chronic condition with genetic a
n
d
neurobiological basis which manifests in early
childhood with symptoms of hyperactivity,
impulsivity, and/or inattention affecting the
emotional, academic, and social functioning of
the child.
Prevalence of ADHD in a community-based
sample in India in school children w
a
s around
11%.
▪ It is more frequently seen in boys than in
girls.

7. Cardinal features
* Inattentiveness
* Hyperactivity
* Impulsivity

8. Inattentiveness
* Doesn’t complete the given task
* Flits from activity to activity
* Gets bored easily
(except cartoon films)
* Makes silly / careless mistakes
* Needs constant supervision
* Doesn’t seem to listen

9. Inattentiveness
* Doesn’t follow instructions
* Doesn’t improve with threat / punishment
* Difficulty in organizing
* Avoids task requiring sustained attention
* Forgetful / Doesn’t remember
* Loses things frequently

10. Hyperactivity
* Constantly fidgety, squirmy & restless
* Can’t keep his hands to self
* Keeps on touching things in the vicinity
* Unable to sit at one place
* Keeps on moving in the class-room
* Very talkative, loud, noisy

11. Hyperactivity
* Answers before the question is asked
* Interrupts / intrudes in the conversation
* Jumpy, doesn’t walk but appears to be
running and dancing on the road
* Appears to be always on the go
* Clumsy and mischievous
* Can’t wait for his turn while playing

12. Impulsivity
* Accident prone, gets hurt easily
* Puts himself and others in awkward
and embarrassing situations
* Ends up breaking things without
such intentions

15. Exclude differential diagnosis
Neurological conditions—autism spectrum disorder,
learning disability, seizure disorder ,fragile X
Emotional disorders—depression, anxiety, mood,
oppositional defiant disorder, conduct disorder,
bipolar, and obsessive compulsive disorder
Psychosocial problems—child abuse, neglect, and
bullying
Medical conditions—hearing/ vision impairment,
substance abuse, and thyroid disorders

16. Consequences
* Unable to pay attention in the class
* Gets easily distracted
* Remains behind in academic performance
* Ends up disturbing the class
* Frequent call-outs in the class
* Gets frequent scolding and punishment
* Becomes a scapegoat / black-sheep
of the class

17. Modalities of Management
• Behavioral interventions— first-line treatment
for preschool children (below 6 years)
• Medication—with or without behavioral
interventions are the first-line therapy for
school-aged children (≥6 years) and
adolescents
• Educational interventions
• Combination of the above

19. Behaviour therapy
• Behavior therapy is an effective treatment that
can improve a child’s behavior, self-control, and
self-esteem
• Parents have the greatest influence on their
young child’s behavior.
•
• Only therapy that focuses on training parents is
recommended for young children with ADHD

20. Behaviour therapy

22. Other points to consider..
• Nutrition
• Sleep hygiene
• Simplify your child’s routine
• ADHD treatment starts at home

24. METHYLPHENIDATE
• START WITH 5-10 MG
BEFORE GOING TO SCHOOL
• GRADUALLY INCREASE TO
20-50 MG IF REQUIRED

25. Atomoxetine
• A new, non-stimulant option for
the treatment of ADHD
• Start with 0.5 mg/kg body weight
i.e. 10 mg or 18 mg as single dose in
the morning
• Increase the dose to 1.2 mg/kg body
weight if required
• It may be given in 2 divided doses

26. How long to continue the treatment?
• The treatment may be continued
for a period of 3-6 months at a
time to a time till the child
matures-out of his ADHD.
• Review every 3-6 months, the
need to continue the treatment