ADHD by Ishfaq Ahmad student SKIMS SOURA SRINAGAR.

1. PRESENTATION BY:
Ishfaq
Ahmad

2. TOPIC : ATTENTION DEFICIT HYPERACTIVITY
DISORDER
SUB TOPICS :
Introduction Diagnosis
Definition Differential Diagnosis
Characteristics Treatment
Epidemology Nursing Interventions
Etiology Follow Up
Types
Clinical Features

3. INTRODUCTION
• Attention deficit hyperactivity disorder (ADHD) is a condition that makes
it difficult for children to pay attention or control their behavior.
• ADHD often co occurs with other emotional,behavioural,launguage and
learning disorders.
• The Syndrome was First discovered by Heinrich Hoff in 1854.

4. DEFINITION
• Attention deficit hyperactivity disorder is a neurodevelopmental disorder
in children characterised by persistent pattern of inattention and/or
hyperactivity.

5. CHARACTERISTICS
• Neurobiological disorder.
• Marked by developmentally inappropriate inattention, impulsivity, and, in
some cases, hyperactivity.
• May progress to Conduct disorder.

6. EPIDEMIOLOGY
• A prevalence of 9 % was found among primary school children globally
,although rates vary considerably from country to country.
• The prevalence rate in adolescent samples is 2-6 %.
• ADHD is 4 times more common in boys than in girls.

7. ETIOLOGY
. Genetic Factors
. Genes e.g DAT1,DRD4,LPHN3.
. Monozygotic > Dizygotic
. Parents with ADHD have > 50% chance of having a child with ADHD.
. Siblings of Hyperactivity children have about twice the risk of having the disorder.
. Biochemical Theory
. A deficit of Dopamine and Norepinephrine has been attributed in the overactivity seen in
ADHD.

8. ETIOLOGY CONT...
. Pre, Peri and Postnatal factors
. Toxic Exposure to lead , Mechanical Insult, smoking and alcohol use.
. Prematurity, Fetal distress, Prolonged labor, Low APGAR score, perinatal asphyxia.
. Postnatal infections, CNS abnormalities.

9. TYPES
• 1) Predominantly Inattentive type
• 2) Predominantly hyperactive–impulsive type
• 3) Combined type

10. 1) INATTENTIVE TYPE
9 Symptoms
• 1. Fails close attention
• 2. Trouble holding attention
• 3. Not seem to listen
• 4. Not follow through on instructions
• 5. Trouble organizing
• 6. Avoids tasks that require mental effort
• 7. Loses things fir tasks and activities
• 8. Easily distracted
• 9. Forgetful in daily activities

11. 2) IMPULSIVE / HYPERACTIVE TYPE
9 Symptoms
1.Trouble waiting for their turn
2. Interrupts or intrudes on others
3. Often blurts out an answer
4. Fidgets with or taps hands or feet
5. Leaves a seat
6. Runs about or climbs
7. ‘ Driven by a motor’
8. Talks Excessively
9. Unable to play quietly

12. CLINICAL MANIFESTATIONS
• Sensitive to stimuli, easily upset by noise, light, temperature etc.
• General coordination deficit.
• Failure to finish tasks.
• Short attention.
• Memory and thinking deficit.

13. DIAGNOSIS
• Careful and complete history that includes;
. History of presenting problems.
. Growth and development.
. Pregnancy complications.
. Family history.
• A psychiatric evaluation.
• Detailed perenatal history e.g maternal smoking,alcohol or illicit drug use.
• School Reports etc.
• Laboratory findings.

14. DIFFERENTIAL DIAGNOSIS
• Anxiety disorder
• Depression
• Oppositional defiant disorder(ODD)
• Conduct disorder

15. TRATMENT GOALS
• A child specific,individualised treatment programme should be developed for children.
• A goal of maximizing function to
. Improve relationship and performance at school,
. Decrease disruptive behaviours,
. Promote safety,
. Increase independence and
. Improve self esteem.

16. TREATMENT OPTIONS
• Medications
• Behaviour and psychotherapies
• Educational techniques

17. TREATMENT
• Pharmacotherapy.
• Stimulants:
.Methylphenidate 5mg BID
.Amphetamine 5MG OD/BID
.Dextroamphetamine 2.5mg BID
• Non stimulants:
.Antidepressants
.Antipsychycotics

18. TREATMENT CONT...
• Psychological therapies.
• Behaviour modification techniques
• CBT
• Social skills training.
• Parent behaviour management training.

19. NURSING INTERVENTION
• Develop a trusting relationship with the child.
• Remove objects from immediate area in which patient could injure self.
• Provide an environment that is from from distractions.
• Ask the patient to repeat instructions before beginning a task.
• Offer recognition for successful attempts and positive reinforcement .
• Help him learn how to take his turn, wait in line and follow rules.
• Explain and demonstrate positive parenting techniques to parents or caregivers.

20. • Ask the patient to repeat instructions before beginning a task.
• Coordinate overall treatment plan with schools, collateral personnel, the child and the
family.

21. FOLLOW UP
• Every 1-3 weeks during initial titration.
• Every 3-6 months thereafter.
• Consider stopping if patient is stable and doing well.Stop for 1-4 weeks then re-evalvate.