A presentation for undergraduate Education on ADHD. for more, and for original PPTXs, visit: https://psych.thinkific.com My question bank: https://psych.thinkific.com/courses/Psychiatry-question-bank-for-MRCPsych

1. Attention –deficit
hyperactivity disorder
(ADHD)
Dr. Saqib Siddique,
Assistant Professor of Psychiatry, PIMC,
Peshawar.
MBBS (KMC), DCP (IRE), FCPS (PAK), Certified
Cognitive Therapist (KMU).

2. Scenario 1
“Musa is constantly forgetting things. His
homework is rarely finished, and his parents
describe homework time as “a nightmare.”
Children with ADHD frequently have
difficulty paying attention top tasks at
hands.

3. Scenario 2
“Osman can hardly stay in his seat during
class and gets up as soon as the bell rings.
During lunchtime, he grabs other students’
food and frequently cuts in line”
Sitting still, or in one place, for a long period
of time is torture for many kids with ADHD.

4. Terms
ADHD and ADD >> DSM 5,
• The American Psychiatric
Association.
• Hyperkinetic Disorder >> ICD 10
• World Health Organization.

5. Definition
• A disorder characterized by three groups of symptoms
• Inattentiveness, hyperactivity and impulsiveness.
• Second most common psychiatric disorder of Childhood.

6. Subtypes
• Predominantly Inattentive
• Hyperactive/Impulsive
• Combined Presentation

7. DSM Diagnostic
Criteria

8. Inattention
• Makes careless mistakes
• Difficulty sustaining attention
• Does not seem to listen when spoken to directly
• Fails to follow tasks and instructions
• Exhibits poor organization
• Avoids tasks requiring mental effort
• Loses things necessary for tasks/activities
• Easily distracted
• Seems forgetful in daily activities

9. Hyperactivity/Impulsivity
• Fidgets with or taps hands or feet, turns in seat
• Leaves seat in situations when remaining seated is expected
• Experiences feelings of restlessness
• Has difficulty engaging in quiet, leisurely activities
• Is “on-the-go” or acts as if “driven by a motor”
• Talks excessively
• Blurts out answers
• Has difficulty waiting their turn
• Interrupts or intrudes on others

10. Other Criteria
9 symptoms in
each category.
6 required to make
the diagnosis.
Onset before
12 year of age.
persisting for 6
months.
Pervasive
across
situations
(Home, Class,
Clinic)
Inappropriate
for
developmental
age.
Impaired
functioning.
Not better
explained by
any other
diagnosis.

11. Epidemiology
Prevalence: 3%
Male to Female ratio: 3:1
Socioeconomic association None

12. Age of Onset
Most diagnosed in 6-to-12-year-old.
Age of onset before 12 per DSM-5
Age of onset before 7 per ICD-10

13. Etiology
• Genetics-Non mendelian polygenic inheritance. Heritability
estimates of ADHD is around 70-80%. Sibling with ADHD.
• Traumatic Brain Injury
• Genes affecting dopamine system

14. Etiology
Maternal Smoking
Prematurity, Low birth weight
Early Psychosocial adversity
(children raised in extreme
deprivation
Toxins such as Pesticides

15. Comorbidities
• Conduct Disorder/Oppositional Defiant Disorder (most common)
• Autism Spectrum Disorder---20-50%
• Tourette's Syndrome/Tics
• Developmental Coordination Disorder
• Substance misuse
• Reading Disorders
• Epilepsy

16. Differentials
• Conduct Disorder/Oppositional Defiant
Disorder (most common)
• Anxiety Disorders
• Mania
• Intellectual Disability
• Epilepsy
• Hearing Impairment
• Receptive Language Disorders

17. Prognosis
• About 50% of cases diagnosed in childhood retain
full diagnosis in adolescence
• About 10-20 % cases diagnosed in childhood retain
diagnosis in Adulthood
• Prognosis is poor when overactivity is severe,
associated with learning difficulties and antisocial
behavior

18. Prognosis
• Adults with ADHD can experience more opportunities
to ‘live with’ the disorder as they no longer need to
attend school with its associated institutional demands
and can choose career paths more suited to their work
patterns and needs.
• Many adults with ADHD describe poor motivation,
inattention and poor organization---Problems at work
and relationships.
• Comorbid mood disorders and substance misuse are
common in Adulthood

19. Prognosis Unmedicated individuals
appear to have higher rates
of:
• Substance Abuse
• Antisocial PD,
• Other PD and psychiatric
disorder,
• Academic failure,
• Unemployment,
• Accidents
Reference:
Barkley 2001, Rasmussen & Gillberg 2000, Biederman et al 1998

20. Assessment
• Full developmental assessment: Pregnancy,
birth, developmental milestones, medical
history, Family history
• Screening Tools/Scales: Connors Rating
Scale( Parent, Teacher and Child version)
• Clinical Interview with parents
• Clinical Interview with Child
• School Information: School report forms or
School visit
• MSE for comorbid Psychiatric conditions
• Psychosocial assessment for needs of child
and carers.

21. Speech and Language assessment.
if delay present.
Screen for comorbidities:
• Tourette’s Syndrome,
• Autism,
• Conduct Disorder

22. Investigations
HEARING TESTS TFTS
RULE OUT HYPERTHYROIDISM
EEG
EPISODIC CHANGES.

23. Treatments
Biological Treatments
Psychosocial Interventions

24. Biological
Treatments
Stimulant Medications:
• Methylphenidate( First-Choice)
• Potential for abuse.
• Short-acting:
• Ritalin
• Long-acting:
• Equasym XL, Concerta XL, Ritalin LA

25. Methylphenidate
• Inhibits reuptake of Dopamine and Norepinephrine (block transporters_
• Increased Dopaminergic/Noradrenergic activity in prefrontal Cortex
• Prefrontal Cortex---regulates attention and behavior
• Difference from Amphetamines: Does not promote dopamine release from
synaptic vesicles.

26. Biological 2) Non-Stimulant Medications :
Atomoxetine ( Straterra)—Nor-
adrenaline reuptake inhibitor
with no potential for abuse.
3) Antipsychotics : Risperidone =
severe co-existing aggression and
agitation in those intellectual
disability

27. Psychosocial
Interventions
1. Education of family
2. Parent training program based on
behavioral interventions

28. Psychosocial
Interventions
Social Skills training
Support to carers
Classroom Interventions ( Small class,
breaks, Seats to the front-not close
by window)
Address any child protection
concerns

29. Frequently asked
questions
Regarding ADHD treatments

30. “Will taking a stimulant
make my child more likely
to take street drugs?”
ADHD increases the risk of your child
developing substance abuse. It
seems from recent research that
your child’s risk may decrease with
use of ADHD medication

31. “What are the long term affects of ADHD
medications?”
Methylphenidate has been in use for over 50 years, so we are aware and monitor for most side effects.
It is believed that treating your child for ADHD is more beneficial than not. Risks of road traffic accidents,
substance misuse and criminality seem to decrease with treated ADHD.

32. Does methylphenidate help
people without ADHD?
>>

33. • Stimulants do not increase IQ (Advokat et al. 2008)
• Students are taking unnecessary risks including the
potential for harmful side effects, which may cause
psychosis sudden death.
• Potential for dependence.
• Do not offer as much help to people with greater
intellectual abilities.

34. Thankyou; this ends the
presentation.
Download the file more from:
Psych.thinkific.com