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.

1. ASSESSMENT OF ADHD
Dr. Kersi Chavda

2. FACT:
ADHD is a clinical diagnosis with no specific
validated biological or cognitive tests.

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. NOTE THAT…
Patients with ADHD, either youth or adult, tend to
under report their ADHD symptoms, so
collaborative history is helpful

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. 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. LAB TESTS:
 Lead levels(not common)
 Thyroid function tests
 Vit B12 levels
 Vit D3 levels
 Iron deficiency
 EEG
 Neuro –imaging
 Genetic testing

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. D/D
 Thyroid disorders
 Foetal -alcohol syndrome
 PANDAS
 Autism and PDD
 Conduct Disorder
 Oppositional Defiant Disorder
 Depressive disorder/Bipolar disorder
 Substance use disorder

10. ONCE DIAGNOSIS OCCURS….
move towards treatment

11. Treatment of ADHD

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. NON- DRUG THERAPY
Behaviour 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. ASPECTS OF BEHAVIOUR THERAPY
 Information and the natural history of the condition
 Learning to observe the child's appropriate and
inappropriate behaviour more carefully
 Using a home “Token economy” system
effectively…positive and negative reinforcements

15. ALSO
 How to use “Time out” effectively
 How to manage non-compliant behaviours in public
 Learning to avoid future behavioural catastrophes

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. 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. 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. 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. 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. 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. PHARMACOLOGICAL TREATMENTS
Consider stimulants like Methylphenidate to be the
first –line drug treatment
Response rates estimated to be between 75 to
80%

23. OTHER MEDICATIONS
 Atomoxetine
 Buproprion
 TCAs
 Clonidine
 Anti-psychotics?
 Anti-epileptics?

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. 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. 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. Thank you