Attention-Deficit Hyperactivity Disorder (ADHD) is a pervasive behavioral syndrome characterized by inattention, hyperactivity, and impulsivity. The document discusses the history and development of ADHD as a concept, diagnostic criteria and features based on the DSM-IV, statistics on prevalence and comorbidities, potential etiologies including genetic and environmental factors, and treatments. Key points include that ADHD affects 3-5% of school-aged children, has a male predominance, and has strong evidence for heritability as the strongest risk factor. Diagnosis involves clinical examination, questionnaires, and determining if criteria are met for inattention and/or hyperactivity-impulsivity in multiple settings.
This document provides information about ADHD medications for teachers, including:
- Stimulant and non-stimulant medications are the main treatment options for ADHD.
- Medications can help improve attention span, reduce hyperactivity, and improve impulse control.
- Potential adverse effects include reduced appetite, insomnia, stomach aches, and irritability."
ADHD is a developmental disorder affecting 3-6% of children that impacts executive function in the brain. It causes problems with attention span, impulse control, and activity level. The main symptoms are inattention, hyperactivity, and impulsivity. While a real disorder, ADHD is often underestimated and management includes medication, therapy, classroom support, and nutrition.
The document discusses Attention Deficit Hyperactivity Disorder (ADHD), including its definition, history of labels used, prevalence rates globally and in India, and characteristics. It provides details on the diagnostic criteria for ADHD according to the DSM-IV and DSM-V, as well as the definition and characteristics according to ICD-10. The document also discusses possible biological contributors to ADHD such as differences found in brain structure and activity levels in regions such as the prefrontal cortex, corpus callosum, striatum, and cerebellum.
Adhd in adults. david carey presentation, hadd meeting, 22 september 2009pdfhaddireland
This document discusses myths and realities about adult ADHD. It dispels the myths that ADHD is a lack of willpower, that everyone experiences ADHD symptoms, that ADHD cannot be comorbid with other conditions, and that it must be diagnosed in childhood. It describes the neurobiological nature of ADHD and lists its core symptoms in adults. It also outlines the negative effects ADHD can have if left untreated, including on health, work, relationships, education and psychological well-being. However, it notes that adult ADHD is highly treatable and manageable with help available in Ireland.
This document provides an overview of Attention Deficit Hyperactivity Disorder (ADHD), including its causes, diagnosis, treatment, and management strategies. It discusses how ADHD is a neurodevelopmental disorder characterized by impulsivity, hyperactivity, and difficulty sustaining attention. The core symptoms are caused by abnormalities in the brain's executive function. ADHD has strong genetic factors and is highly inheritable. Effective treatment involves medication, behavioral therapy, education/accommodations, and support systems.
This document provides information about ADHD medications for teachers, including:
- Stimulant and non-stimulant medications are the main treatment options for ADHD.
- Medications can help improve attention span, reduce hyperactivity, and improve impulse control.
- Potential adverse effects include reduced appetite, insomnia, stomach aches, and irritability."
ADHD is a developmental disorder affecting 3-6% of children that impacts executive function in the brain. It causes problems with attention span, impulse control, and activity level. The main symptoms are inattention, hyperactivity, and impulsivity. While a real disorder, ADHD is often underestimated and management includes medication, therapy, classroom support, and nutrition.
The document discusses Attention Deficit Hyperactivity Disorder (ADHD), including its definition, history of labels used, prevalence rates globally and in India, and characteristics. It provides details on the diagnostic criteria for ADHD according to the DSM-IV and DSM-V, as well as the definition and characteristics according to ICD-10. The document also discusses possible biological contributors to ADHD such as differences found in brain structure and activity levels in regions such as the prefrontal cortex, corpus callosum, striatum, and cerebellum.
Adhd in adults. david carey presentation, hadd meeting, 22 september 2009pdfhaddireland
This document discusses myths and realities about adult ADHD. It dispels the myths that ADHD is a lack of willpower, that everyone experiences ADHD symptoms, that ADHD cannot be comorbid with other conditions, and that it must be diagnosed in childhood. It describes the neurobiological nature of ADHD and lists its core symptoms in adults. It also outlines the negative effects ADHD can have if left untreated, including on health, work, relationships, education and psychological well-being. However, it notes that adult ADHD is highly treatable and manageable with help available in Ireland.
This document provides an overview of Attention Deficit Hyperactivity Disorder (ADHD), including its causes, diagnosis, treatment, and management strategies. It discusses how ADHD is a neurodevelopmental disorder characterized by impulsivity, hyperactivity, and difficulty sustaining attention. The core symptoms are caused by abnormalities in the brain's executive function. ADHD has strong genetic factors and is highly inheritable. Effective treatment involves medication, behavioral therapy, education/accommodations, and support systems.
This document provides an overview of Attention Deficit Hyperactivity Disorder (ADHD), including its main symptoms, types, causes, treatments, and preventions. ADHD is a mental illness commonly diagnosed in young people characterized by inattention, hyperactivity, and impulsivity. There are three main types - predominantly inattentive, predominantly hyperactive/impulsive, and a combination of both. While the exact causes are unknown, ADHD tends to be hereditary and may involve chemical imbalances or brain changes. Treatment focuses on medication and therapy to control symptoms, as ADHD cannot be cured. Prevention strategies include avoiding toxins, head injuries, smoking/drinking during pregnancy, and maintaining a healthy diet.
ADHD is a common childhood disorder characterized by inattention, hyperactivity, and impulsiveness. It is caused by differences in brain development and may run in families. Symptoms include lack of attention, hyperactivity, and impulsive behavior. Treatment involves medication, behavior therapy, and support systems to help manage symptoms and prevent associated problems.
ADHD is a common disorder affecting 3-5% of school-aged children. It is characterized by inattentiveness, hyperactivity, and impulsivity. Diagnosis involves evaluating symptoms, which must be present in multiple settings, and determining impairment. Treatment may include behavioral therapy, environmental modifications, medications like stimulants, and an IEP. Nurses play an important role in medication administration, safety, behavioral observation, advocacy, and supporting adherence to treatment plans.
This document provides an overview of attention-deficit/hyperactivity disorder (ADHD). It discusses that ADHD is a neuropsychiatric condition affecting people worldwide, characterized by diminished sustained attention, increased impulsivity, and hyperactivity. The worldwide prevalence is estimated to be 5.29%. Genetic factors play a large role in its etiology, and treatments include stimulant medications like methylphenidate and non-stimulant medications like atomoxetine. The diagnosis of ADHD is based on criteria from the DSM-5 and involves symptoms of inattention, hyperactivity, and impulsivity interfering with functioning.
1. ADHD is a neurobehavioral disorder characterized by inattention, hyperactivity, and impulsivity. It affects about 5-9% of school-aged children in the US.
2. There are three main subtypes of ADHD - inattentive, hyperactive/impulsive, and combined presentation. Symptoms must be present before age 12 and persist for at least 6 months.
3. Effective treatment involves a comprehensive approach including medication management, behavioral therapy, education/academic supports, and lifestyle changes like regular exercise and sleep routines.
CCS would like to encourage your attendance for the 2012 Latino Mental Behavioral Health Conference: Changing the Paradigm from Stigma to Wellness on Friday, October 19th at the Chicago School of Professional Psychology.
Come listen to Psychiatrist Dr. Daniel Martinez discuss the neuroanatomical basis of brain disorders, focusing on the biopsychosocial medical model, areas of the brain affecting emotions and psychiatric disorders with a clear medical basis.
ADHD stands for Attention Deficit Hyperactivity Disorder. ADHD is one of the most common disorders; it is usually first diagnosed in childhood and often lasts till adulthood. ADHD causes symptoms like having trouble paying attention, controlling impulsive behaviors and being overly active. People suffering from ADHD find it hard to concentrate on a subject. They also find it difficult to follow detailed instructions, organizing tasks and planning schedules. People with ADHD are easily distracted by little things around, external stimuli and often lose things. Visit Our Website : https://mindsightclinic.com/a-z-issues/adhd
This document discusses attention-deficit hyperactivity disorder (ADHD). It defines ADHD as a psychiatric disorder characterized by inattention prior to age 7. Common symptoms include fidgeting and difficulty focusing. The document explains that ADHD is caused by low levels of neurotransmitters like dopamine in the brain. Treatment focuses on behavioral modifications with consistency from parents, teachers, and caregivers. The goal is for children to understand their condition and advocate for themselves.
What is Attention-Deficit/Hyperactivity Disorder?
Inattentive, hyperactive & impulsive to excessive degree compared with their peers.
For more info, download the presentation.
Babatunde Idowu Ogundipe M.D. M.P.H.
Comprehensive Clinical Services P.C.
October 7 2011
Topic 8 - Treatment for ADHD.
Autism, Asperger's and ADHD.
The views expressed in this presentation are those of the individual Simon Bignell and not University of Derby.
The document provides an overview of Attention Deficit Hyperactivity Disorder (ADHD), including its definition, clinical presentation, diagnosis criteria according to DSM-V, epidemiology, common comorbidities, prognosis, and management approaches. ADHD is defined as a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. It affects about 5-8% of children and 2.5% of adults worldwide, and diagnosis involves evaluating symptoms, impairment, age of onset, and ruling out alternative causes according to DSM-V criteria. Management involves behavioral interventions, stimulant medications, and other pharmacological and non-pharmacological options.
Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood disorders that can persist into adulthood. It is caused by deficiencies in two neurotransmitters in the brain. Symptoms include fidgeting, distraction, excessive talking, and disorganization. Treatment includes medication, behavioral therapy, education, and lifestyle changes like diet and exercise. Managing ADHD requires a team approach with parents, teachers, doctors, and the patient working together.
ADHD is a disorder characterized by inattention and/or hyperactivity that interferes with functioning or development. It typically emerges early in life by age 7 and symptoms are most severe during elementary school. It is defined by at least 6 symptoms of inattention and/or 6 of hyperactivity/impulsivity according to the DSM-IV criteria. ADHD occurs worldwide with a prevalence of 3-7% in school-aged children and tends to run in families. It is diagnosed based on the number and severity of symptoms, ruling out alternative causes, and impairment in functioning.
This document summarizes a conference on new developments in pharmacological and therapeutic interventions for ADHD. Dr. Gabriel Kaplan and Dr. Bennett Silver presented on various topics. Dr. Kaplan discussed ADHD epidemiology and diagnosis, as well as non-stimulant treatments and new approaches. Dr. Silver presented on stimulant medications and non-medication approaches. The document provides an agenda and background on the speakers. It also reviews stimulant treatment options, side effects, and considerations for non-stimulant use.
This document provides information about Attention Deficit Hyperactivity Disorder (ADHD), including what it is, common signs and symptoms, and tips for managing it at home. ADHD is a neurodevelopmental disorder characterized by inattention, impulsivity, and hyperactivity. It is caused by underactivity in the frontal lobes of the brain. Common signs include difficulty sustaining attention, problems with impulse control, and hyperactivity. Effective management involves frequent positive feedback, clear rules and consequences, structure, patience, and understanding that behaviors are due to the disorder rather than the child. Resources for parents include support groups and educational books and materials.
ADHD is a common neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. It affects about 5% of children worldwide, with boys being diagnosed three times as often as girls. There are three main presentations of ADHD - predominantly inattentive, predominantly hyperactive/impulsive, and combined type. Diagnosis involves ruling out other possible causes and observing symptoms cross several environments. Treatment typically involves medication, behavioral therapy, and educational accommodations to help manage symptoms and improve functioning.
Attention-deficit/hyperactivity disorder (ADHD) is a neurobehavioral disorder characterized by inattentiveness, hyperactivity, and impulsivity. It is estimated to affect 3-7% of school-aged children, with boys being diagnosed more often than girls. Symptoms include difficulty paying attention, sitting still, and controlling impulsive behaviors. If left untreated, ADHD can negatively impact academic performance, career success, and social-emotional development. Treatment involves medication, therapy, behavior modification, and education to help manage symptoms.
Attention deficit hyperactivity disorder (ADHD, similar to hyperkinetic disorder in the ICD-10) is a neurodevelopmental psychiatric disorder in which there are significant problems with executive functions (e.g., attentional control and inhibitory control) that cause attention deficits, hyperactivity, or impulsiveness which is not appropriate for a person's age.
Hyperkinetic disorder, also known as attention deficit hyperactivity disorder (ADHD), is characterized by inattentive, restless and impulsive behavior. It is caused by both genetic and environmental factors and affects 5-10% of school-aged children. The three main subtypes are inattentive, hyperactive-impulsive, and combined type. Diagnosis involves evaluating symptoms such as inattention, hyperactivity and impulsivity, which must be present before age 7 and impair functioning. Treatment includes behavioral therapy, psychosocial interventions, and medications like stimulants and antidepressants. Comorbid conditions are common and outcomes vary depending on the individual and treatments.
The document discusses ADHD, defining it as a behavior disorder characterized by inattention, hyperactivity, and impulsivity that interferes with functioning. It notes the three key symptoms and provides examples of how each manifest. The text emphasizes the importance of early recognition and treatment, as ADHD behaviors are typically outgrown in non-ADHD children but can cause long-term problems if left unaddressed. Suggested treatments include limiting distractions, one-on-one instruction, sufficient sleep, and a healthy diet.
1) ADHD is a neurobiological disorder that affects children and leads to symptoms of inattention, impulsivity, and hyperactivity.
2) These symptoms are present in everyone but are more predominant in individuals with ADHD.
3) Left untreated, ADHD can have negative impacts such as higher rates of smoking, substance abuse, antisocial tendencies, and an economic burden of over $30 billion in the United States each year.
Antidepressants have several surprising effects: Prozac in water makes shrimp act erratically due to increased serotonin; all antidepressants are equally effective for depression but have different costs and side effects; SSRIs can both decrease and increase libido by causing sexual dysfunction but also treating premature ejaculation; and long term sexual, bone, and cognitive side effects from SSRIs are still under investigation.
This document provides an overview of Attention Deficit Hyperactivity Disorder (ADHD), including its main symptoms, types, causes, treatments, and preventions. ADHD is a mental illness commonly diagnosed in young people characterized by inattention, hyperactivity, and impulsivity. There are three main types - predominantly inattentive, predominantly hyperactive/impulsive, and a combination of both. While the exact causes are unknown, ADHD tends to be hereditary and may involve chemical imbalances or brain changes. Treatment focuses on medication and therapy to control symptoms, as ADHD cannot be cured. Prevention strategies include avoiding toxins, head injuries, smoking/drinking during pregnancy, and maintaining a healthy diet.
ADHD is a common childhood disorder characterized by inattention, hyperactivity, and impulsiveness. It is caused by differences in brain development and may run in families. Symptoms include lack of attention, hyperactivity, and impulsive behavior. Treatment involves medication, behavior therapy, and support systems to help manage symptoms and prevent associated problems.
ADHD is a common disorder affecting 3-5% of school-aged children. It is characterized by inattentiveness, hyperactivity, and impulsivity. Diagnosis involves evaluating symptoms, which must be present in multiple settings, and determining impairment. Treatment may include behavioral therapy, environmental modifications, medications like stimulants, and an IEP. Nurses play an important role in medication administration, safety, behavioral observation, advocacy, and supporting adherence to treatment plans.
This document provides an overview of attention-deficit/hyperactivity disorder (ADHD). It discusses that ADHD is a neuropsychiatric condition affecting people worldwide, characterized by diminished sustained attention, increased impulsivity, and hyperactivity. The worldwide prevalence is estimated to be 5.29%. Genetic factors play a large role in its etiology, and treatments include stimulant medications like methylphenidate and non-stimulant medications like atomoxetine. The diagnosis of ADHD is based on criteria from the DSM-5 and involves symptoms of inattention, hyperactivity, and impulsivity interfering with functioning.
1. ADHD is a neurobehavioral disorder characterized by inattention, hyperactivity, and impulsivity. It affects about 5-9% of school-aged children in the US.
2. There are three main subtypes of ADHD - inattentive, hyperactive/impulsive, and combined presentation. Symptoms must be present before age 12 and persist for at least 6 months.
3. Effective treatment involves a comprehensive approach including medication management, behavioral therapy, education/academic supports, and lifestyle changes like regular exercise and sleep routines.
CCS would like to encourage your attendance for the 2012 Latino Mental Behavioral Health Conference: Changing the Paradigm from Stigma to Wellness on Friday, October 19th at the Chicago School of Professional Psychology.
Come listen to Psychiatrist Dr. Daniel Martinez discuss the neuroanatomical basis of brain disorders, focusing on the biopsychosocial medical model, areas of the brain affecting emotions and psychiatric disorders with a clear medical basis.
ADHD stands for Attention Deficit Hyperactivity Disorder. ADHD is one of the most common disorders; it is usually first diagnosed in childhood and often lasts till adulthood. ADHD causes symptoms like having trouble paying attention, controlling impulsive behaviors and being overly active. People suffering from ADHD find it hard to concentrate on a subject. They also find it difficult to follow detailed instructions, organizing tasks and planning schedules. People with ADHD are easily distracted by little things around, external stimuli and often lose things. Visit Our Website : https://mindsightclinic.com/a-z-issues/adhd
This document discusses attention-deficit hyperactivity disorder (ADHD). It defines ADHD as a psychiatric disorder characterized by inattention prior to age 7. Common symptoms include fidgeting and difficulty focusing. The document explains that ADHD is caused by low levels of neurotransmitters like dopamine in the brain. Treatment focuses on behavioral modifications with consistency from parents, teachers, and caregivers. The goal is for children to understand their condition and advocate for themselves.
What is Attention-Deficit/Hyperactivity Disorder?
Inattentive, hyperactive & impulsive to excessive degree compared with their peers.
For more info, download the presentation.
Babatunde Idowu Ogundipe M.D. M.P.H.
Comprehensive Clinical Services P.C.
October 7 2011
Topic 8 - Treatment for ADHD.
Autism, Asperger's and ADHD.
The views expressed in this presentation are those of the individual Simon Bignell and not University of Derby.
The document provides an overview of Attention Deficit Hyperactivity Disorder (ADHD), including its definition, clinical presentation, diagnosis criteria according to DSM-V, epidemiology, common comorbidities, prognosis, and management approaches. ADHD is defined as a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. It affects about 5-8% of children and 2.5% of adults worldwide, and diagnosis involves evaluating symptoms, impairment, age of onset, and ruling out alternative causes according to DSM-V criteria. Management involves behavioral interventions, stimulant medications, and other pharmacological and non-pharmacological options.
Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood disorders that can persist into adulthood. It is caused by deficiencies in two neurotransmitters in the brain. Symptoms include fidgeting, distraction, excessive talking, and disorganization. Treatment includes medication, behavioral therapy, education, and lifestyle changes like diet and exercise. Managing ADHD requires a team approach with parents, teachers, doctors, and the patient working together.
ADHD is a disorder characterized by inattention and/or hyperactivity that interferes with functioning or development. It typically emerges early in life by age 7 and symptoms are most severe during elementary school. It is defined by at least 6 symptoms of inattention and/or 6 of hyperactivity/impulsivity according to the DSM-IV criteria. ADHD occurs worldwide with a prevalence of 3-7% in school-aged children and tends to run in families. It is diagnosed based on the number and severity of symptoms, ruling out alternative causes, and impairment in functioning.
This document summarizes a conference on new developments in pharmacological and therapeutic interventions for ADHD. Dr. Gabriel Kaplan and Dr. Bennett Silver presented on various topics. Dr. Kaplan discussed ADHD epidemiology and diagnosis, as well as non-stimulant treatments and new approaches. Dr. Silver presented on stimulant medications and non-medication approaches. The document provides an agenda and background on the speakers. It also reviews stimulant treatment options, side effects, and considerations for non-stimulant use.
This document provides information about Attention Deficit Hyperactivity Disorder (ADHD), including what it is, common signs and symptoms, and tips for managing it at home. ADHD is a neurodevelopmental disorder characterized by inattention, impulsivity, and hyperactivity. It is caused by underactivity in the frontal lobes of the brain. Common signs include difficulty sustaining attention, problems with impulse control, and hyperactivity. Effective management involves frequent positive feedback, clear rules and consequences, structure, patience, and understanding that behaviors are due to the disorder rather than the child. Resources for parents include support groups and educational books and materials.
ADHD is a common neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. It affects about 5% of children worldwide, with boys being diagnosed three times as often as girls. There are three main presentations of ADHD - predominantly inattentive, predominantly hyperactive/impulsive, and combined type. Diagnosis involves ruling out other possible causes and observing symptoms cross several environments. Treatment typically involves medication, behavioral therapy, and educational accommodations to help manage symptoms and improve functioning.
Attention-deficit/hyperactivity disorder (ADHD) is a neurobehavioral disorder characterized by inattentiveness, hyperactivity, and impulsivity. It is estimated to affect 3-7% of school-aged children, with boys being diagnosed more often than girls. Symptoms include difficulty paying attention, sitting still, and controlling impulsive behaviors. If left untreated, ADHD can negatively impact academic performance, career success, and social-emotional development. Treatment involves medication, therapy, behavior modification, and education to help manage symptoms.
Attention deficit hyperactivity disorder (ADHD, similar to hyperkinetic disorder in the ICD-10) is a neurodevelopmental psychiatric disorder in which there are significant problems with executive functions (e.g., attentional control and inhibitory control) that cause attention deficits, hyperactivity, or impulsiveness which is not appropriate for a person's age.
Hyperkinetic disorder, also known as attention deficit hyperactivity disorder (ADHD), is characterized by inattentive, restless and impulsive behavior. It is caused by both genetic and environmental factors and affects 5-10% of school-aged children. The three main subtypes are inattentive, hyperactive-impulsive, and combined type. Diagnosis involves evaluating symptoms such as inattention, hyperactivity and impulsivity, which must be present before age 7 and impair functioning. Treatment includes behavioral therapy, psychosocial interventions, and medications like stimulants and antidepressants. Comorbid conditions are common and outcomes vary depending on the individual and treatments.
The document discusses ADHD, defining it as a behavior disorder characterized by inattention, hyperactivity, and impulsivity that interferes with functioning. It notes the three key symptoms and provides examples of how each manifest. The text emphasizes the importance of early recognition and treatment, as ADHD behaviors are typically outgrown in non-ADHD children but can cause long-term problems if left unaddressed. Suggested treatments include limiting distractions, one-on-one instruction, sufficient sleep, and a healthy diet.
1) ADHD is a neurobiological disorder that affects children and leads to symptoms of inattention, impulsivity, and hyperactivity.
2) These symptoms are present in everyone but are more predominant in individuals with ADHD.
3) Left untreated, ADHD can have negative impacts such as higher rates of smoking, substance abuse, antisocial tendencies, and an economic burden of over $30 billion in the United States each year.
Antidepressants have several surprising effects: Prozac in water makes shrimp act erratically due to increased serotonin; all antidepressants are equally effective for depression but have different costs and side effects; SSRIs can both decrease and increase libido by causing sexual dysfunction but also treating premature ejaculation; and long term sexual, bone, and cognitive side effects from SSRIs are still under investigation.
This document discusses suicide prevention. It begins by providing statistics on suicide rates worldwide and in the US. It then discusses risk factors for suicide, including demographic, psychiatric, psychological, and childhood trauma factors. Protective factors are also outlined. The document emphasizes that most suicides can be prevented by learning to recognize warning signs and knowing how to respond. Key warning signs of suicide are listed. Myths and facts about suicide are also presented. In summary, the document aims to raise awareness about suicide and prevention efforts.
Stress can have biological impacts through activation of the sympathetic nervous system and HPA axis, releasing hormones like cortisol. Prolonged stress can accumulate as allostatic load and damage the hippocampus over time, impacting memory. Studies link stress and shorter telomeres, a marker of biological aging, showing the lasting impacts of stress on the body. Effective stress management utilizes strategies like exercise, relaxation, and social support.
This document discusses psychiatric emergencies from the perspective of Prof. Hani Hamed Dessoki, Chairman of the Psychiatry Department at Beni Suef University in Egypt. It covers key topics in psychiatric emergencies including evaluation challenges due to heterogeneity, importance of documentation, exclusion of organic causes, epidemiology, seasonal variations, clinical evaluation process, and management of specific emergencies like suicide, aggression/violence, catatonia, and neuroleptic malignant syndrome. Intervention tools discussed include both non-pharmacological and pharmacological approaches.
Hani hamed dessoki, telomeres and depressionHani Hamed
A new study found that people who had experienced depression had significantly shorter telomeres, representing about 4 to 6 years of accelerated aging at the cellular level. Telomeres are structures at the end of chromosomes that protect DNA from damage. Shorter telomeres have been linked to aging. The study of over 2,400 people showed that those with a history of depression had telomeres about 83 to 84 base pairs shorter than those without depression, even after accounting for other lifestyle factors. While the study did not prove cause and effect, depression is known to disrupt many physical systems, and these findings suggest psychological distress from depression may lead to accelerated biological aging.
This document discusses serotonin synthesis and degradation. It notes that tryptophan is converted to 5-hydroxytryptophan (5-HTP) by tryptophan hydroxylase, and 5-HTP is then converted to serotonin by 5-hydroxytryptophan decarboxylase. Serotonin is broken down by monoamine oxidase. It also discusses the roles of various serotonin receptors, including that 5-HT1A receptors accelerate dopamine while 5-HT2A receptors act as a brake on dopamine. Finally, it concludes that glutamate acts as an accelerator or brake on dopamine depending on the brain area, and that atypical antipsychotics can decrease dopamine in some areas through dual actions
Antidepressants can have surprising effects on animals and people. Prozac in waterways has been shown to make shrimp act erratically by increasing serotonin levels without affecting their mood. While all antidepressants have similar effectiveness, their costs can vary widely with generic versions costing much less. Antidepressants can both positively and negatively impact users' sex lives by delaying ejaculation but also potentially causing long-term sexual side effects.
This document discusses recent updates on the treatment of schizophrenia. It summarizes that cognitive behavioral therapy has the strongest evidence for reducing symptoms in outpatients. It also discusses other therapies like compliance therapy and supportive therapy. Future research may explore using psychotherapy to support patients emotionally, enhance recovery of functioning, or alter the underlying illness process. The document also summarizes recent findings that schizophrenia may be linked to increased risk of autoimmune diseases, and that sodium benzoate shows promise as an adjunct treatment for improving symptoms and cognition in schizophrenia.
This document summarizes a study on psychiatric symptoms among children with congenital heart disease. The study aimed to examine depressive and anxiety symptoms as well as neurocognitive deficits in children with congenital heart disease compared to controls. It found that children with congenital heart disease performed significantly worse on tests of cognitive functioning and had higher levels of depressive and anxiety symptoms than controls. Common psychiatric diagnoses among the children with heart disease included adjustment disorder and depression. The results suggest children with congenital heart disease are at increased risk for psychological and cognitive issues.
This document discusses understanding marital conflicts in Egyptian culture. It provides statistics showing that divorce rates in Egypt have increased significantly in recent decades. Marital conflicts arise from problems with communication, feelings of neglect, disrespect, anger, and loneliness. Successful marriages are characterized by affection, positive communication, mutual childcare responsibilities, and effective conflict resolution. Distressed marriages involve more punishment and criticism rather than positive exchanges. Understanding cultural factors is important for addressing marital conflicts in Egypt, such as changing social norms around responsibility in marriage and differing responses to problems compared to the past.
Hani hamed dessoki, telomeres and depressionHani Hamed
A study of over 2,400 people found that those with a history of depression had significantly shorter telomeres, representing about 4 to 6 years of accelerated aging at the cellular level. Telomeres are structures at the end of chromosomes that protect DNA from damage. Shorter telomeres have been linked to aging and age-related diseases. While the study does not prove causation, depression is known to disrupt many physical systems in the body and this cellular evidence suggests psychological distress from depression may accelerate biological aging. Further research is still needed to understand the implications and potential for intervention.
This document discusses the management of pervasive developmental disorder (autism). It begins with a brief history of autism from Kanner's initial description in 1943. It then describes the core characteristics and clinical presentation of autism including deficits in social behavior, communication problems, and unusual behaviors. It discusses the rising rates of autism as well as common comorbid conditions. Etiology is unknown but believed to have a biological basis. Prognosis varies but symptoms typically persist throughout life.
This document discusses adolescent depression, including its history, scope, causes, clinical manifestations, suicide risk, and management. It notes that depression is a common and serious medical illness in adolescents, with a prevalence of 4-8% having experienced depression in the past year. Left untreated, adolescent depression can lead to suicide, which is a leading cause of death among youth. The document explores the complexities in diagnosing and treating depression in adolescents due to developmental factors and outlines approaches to assessing and managing adolescent depression.
This document provides information on the treatment of schizophrenia including:
- Core symptoms of schizophrenia and their association with brain circuits.
- The development of antipsychotic medications from the 1930s to present, including first and second generation antipsychotics.
- Principles for individualizing treatment with antipsychotic medications to promote recovery, safety, tolerability, quality of life, and value.
- Factors to consider when choosing an antipsychotic such as treatment history, comorbidities, adherence, and demographics.
Dopamine pathways in the brain are implicated in schizophrenia. Hypoactivity in dopamine pathways is associated with negative and cognitive symptoms, while hyperactivity is linked to positive symptoms. Serotonin and catecholamine synthesis and degradation pathways are also involved. Dopamine levels in the mesolimbic pathway correlate with positive symptoms, while levels in the DLPFC and VMPFC regions correlate with negative symptoms and cognitive dysfunction respectively.
This document discusses recent updates on the treatment of schizophrenia. It summarizes that cognitive behavioral therapy has the strongest evidence for reducing symptoms in outpatients. It also discusses other therapies like compliance therapy and supportive therapy. Future research may explore different goals of psychotherapy like providing support, enhancing recovery, or altering the illness process. The document also summarizes that new data shows individuals with schizophrenia have an increased risk of autoimmune diseases, and that an immune system protein may be linked to late-onset schizophrenia.
This document discusses myths and facts about ADHD, including that it is a real medical condition and not caused by bad parenting. It describes the three types of ADHD and explains that not all cases involve hyperactivity. The document then outlines diagnostic criteria from the DSM-V and discusses treatments like counseling, medication, dietary changes, exercise, and alternative therapies. It provides information on how ADHD affects the brain and describes approaches like FIT classrooms that incorporate movement.
Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurobehavioral disorders in children characterized by inattention, hyperactivity, and impulsivity. It is diagnosed based on symptoms that cause impairment in multiple settings according to the DSM-IV criteria. Treatment involves psychosocial interventions, behavior management training, and stimulant medication which effectively treat the core symptoms of ADHD.
This document provides an overview of attention deficit hyperactivity disorder (ADHD). It discusses the definition, causes, pathogenesis, subtypes, presentation, diagnosis, comorbidities, differential diagnosis, management, and prognosis of ADHD. Some key points include:
- ADHD is characterized by inattention, hyperactivity, and impulsivity. It is one of the most commonly diagnosed childhood disorders.
- It has genetic and environmental causes and is associated with differences in brain areas involved in executive function.
- Diagnosis involves clinical evaluation, rating scales, physical exam, and ruling out other potential causes. Stimulant medication and behavioral therapy are common treatment approaches.
- Prognosis is generally good with treatment, though
This paper discusses physiotherapy management for attention deficit hyperactivity disorder (ADHD). It defines ADHD and outlines its types, symptoms, comorbidities, and diagnostic criteria. It describes the pathophysiology involving dopamine and norepinephrine neurotransmitters. Management includes stimulant and non-stimulant medications as well as physiotherapy interventions targeting motor skills, sensory integration, strength, and lifestyle factors like diet and exercise. Physiotherapy is beneficial for both physical problems and improving social/attention skills for those with ADHD.
Attention deficit hyperactivity disorder (ADHD) is a common childhood neurological disorder characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity. It is estimated to affect approximately 5% of children worldwide. Children with ADHD may struggle with inattention, hyperactivity, impulsivity, and difficulty completing tasks. If left untreated, ADHD can cause problems with conduct, academics, relationships and substance abuse later in life. While the exact causes are unknown, genetics and biochemical imbalances are thought to play a role. Treatment involves medication, behavioral therapy, environmental modifications and nursing care focused on safety, social skills, routines and family support.
This document provides guidelines for the assessment and management of ADHD in children and adolescents. It discusses what ADHD is, risk factors, diagnosis, comorbidities, treatment options including pharmacological and non-pharmacological approaches. Symptoms of ADHD include inattention, hyperactivity and impulsivity. Treatment aims to reduce core symptoms, prevent complications, and improve quality of life. Stimulant medications are often first-line treatment but can cause side effects that require monitoring and management.
Attention deficit hyperactivity disorder (ADHD) is a common childhood neurological disorder characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity. It is estimated to affect approximately 5% of children worldwide. Children with ADHD may struggle with inattention, hyperactivity, impulsivity, difficulty following instructions, poor organization skills and distractibility. If left untreated, ADHD can lead to conduct problems, academic struggles, depression and relationship issues. While the exact causes are unknown, genetics and biochemical imbalances are thought to play a role. Treatment involves medication, behavioral therapy, environmental modifications and nursing care focused on safety, social skills and family support.
ADHD is a medical condition that affects attention, focus, and impulse control. It is diagnosed when symptoms of inattention, hyperactivity, and impulsivity are persistent for at least 6 months. Diagnosis involves evaluating symptoms, history, and ruling out other potential causes. While the exact causes are unknown, genetics and environmental factors during development likely play a role. Treatment typically involves medication, behavior therapy, or a combination to help manage symptoms at home and school. Medications can reduce hyperactivity but have potential side effects, so behavior techniques are often recommended initially to teach new strategies.
ADHD is a neurodevelopmental disorder characterized by inattention and/or hyperactivity-impulsivity. It affects 5-8% of children and persists into adulthood in approximately 60% of cases. Boys are more likely to be affected than girls. ADHD is diagnosed based on symptoms interfering with functioning in multiple settings. While the exact causes are unknown, genetic factors and executive function deficits play a role. Treatment involves behavioral therapy and stimulant medications, with methylphenidate and dexmethylphenidate being first line medication options.
Attention Deficit Disorder with Hyperactivity (ADHD)ishamagar
This document discusses attention deficit disorder (ADD), including its four types and their characteristics. It provides details on symptoms, causes, diagnosis criteria, and treatment approaches for ADD with hyperactivity (ADHD). Key information includes that ADHD is one of the most common childhood disorders, affecting 3-5% of school-aged children. It involves inattention, hyperactivity, and impulsivity. Treatment may involve behavioral therapy, pharmacological therapy with stimulants or non-stimulants, or a combination approach depending on the child's age. Nursing management focuses on ensuring a safe environment and developing a trusting relationship to encourage the child.
This document discusses attention deficit hyperactivity disorder (ADHD), including its prevalence in children, symptoms, types, causes, treatment options, and tips for supporting children with ADHD. Some key points include:
- ADHD affects 5-10% of school-aged children in the US, with boys being diagnosed more often than girls. Symptoms include inattention, hyperactivity, and impulsivity.
- There are three main types of ADHD: predominantly inattentive, predominantly hyperactive-impulsive, and combined presentation.
- Causes are believed to include changes in brain structure and genetics, as well as environmental factors like exposure to chemicals during pregnancy or childhood.
-
This document discusses guidelines for ADHD. It provides a brief history of how ADHD has been conceptualized over time, from defects in moral character to its current classification in the DSM-5 as a neurodevelopmental disorder. The document also discusses prevalence rates, symptoms, diagnosis, comorbidities, pathogenesis involving dopamine and norepinephrine systems, and multimodal treatment approaches including medication, behavioral modifications, and family counseling.
This document provides an overview of attention deficit hyperactivity disorder (ADHD), including its symptoms, diagnosis, causes, treatment and prognosis. It discusses how ADHD is characterized by inattention, hyperactivity and impulsivity. It outlines the DSM-V criteria for diagnosing ADHD and describes common comorbidities. Regarding treatment, it discusses behavioral interventions, psychoeducation, medication approaches and their goals of managing symptoms to improve functioning. The prognosis is that symptoms often persist into adulthood, so treatment aims to mitigate long-term risks through multimodal support.
Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood disorders characterized by difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity. While the exact causes are unknown, genetics and environmental factors likely play a role. ADHD is diagnosed through a comprehensive evaluation by a licensed health professional considering behaviors, development, and environment over several months. Effective treatments include medications and psychotherapy to help manage symptoms.
ADHD is one of the most common childhood disorders characterized by difficulty paying attention, hyperactivity, and impulsivity. It is caused by a combination of genetic and environmental factors. Diagnosis involves ruling out other potential causes and determining that symptoms negatively impact daily functioning. Treatment typically involves stimulant medications, which can improve focus and reduce hyperactivity, as well as psychotherapy. While there is no cure for ADHD, treatment can effectively manage symptoms.
Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder characterized by problems with inattention, hyperactivity, and impulsivity. Symptoms must appear by age 12 and occur in more than one environment. There are three subtypes: predominantly inattentive, predominantly hyperactive-impulsive, and combined presentation. While the exact causes are unknown, research suggests genetics and chemical imbalances in the brain may play a role. Treatment typically involves behavioral therapies, medication, exercise, and diet changes to manage symptoms and improve functioning.
ADHD is a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. It affects about 5% of children and 2.5% of adults globally. Genetics play a major role in causation, with heritability estimated around 75-80%. Neuroimaging studies show decreased prefrontal cortex volume and activity. Stimulant medications and behavioral therapies are effective treatments. Left untreated, individuals with ADHD are at higher risk for academic underachievement, accidents, substance abuse, and legal/occupational problems.
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2. Attention-Deficit Hyperactivity
Disorder, Early Detection
Prof. Hani Hamed Dessoki, M.D.PsychiatryProf. Hani Hamed Dessoki, M.D.Psychiatry
Prof. PsychiatryProf. Psychiatry
Chairman of Psychiatry DepartmentChairman of Psychiatry Department
Beni Suef UniversityBeni Suef University
APA memberAPA member
3. DisclosureDisclosure
• NO relevant financial relationships with aNO relevant financial relationships with a
commercial interest.commercial interest.
4. Outline of Presentation
I. History of ADHD
II. Diagnosis and Associative Features
III. Statistics
IV. Etiology
A. Environmental Theories
B. Biogenic Theories
V. Prognosis and Impact
VI. Treatment
5. Attention Deficit Hyperactivity
Disorder (ADHD(
ADHD is a pervasive, heterogeneous
behavioural syndrome characterised by
the core symptoms of inattention,
hyperactivity and impulsivity.
6. ADHD: Historical Development of the Concept
1902: George Still identified impulse control difficulties in some children
1950s: Medical model explanations predominated: “minimal brain damage”,
and “educationally subnormal” labels were used
1970s: Psychological/Familial/Environmental models gained ground:
individual and family coping strategies were emphasised
1980s: In the USA, “Attention Deficit Disorder” had been added to DSMIII
1990s: Concept of “Attention Deficit” and ADHD gained ground in the U.K.
In the U.S., DSMIV added “hyperactivity” to the main diagnosis and
ADD became one of the sub-categories.
8. Diagnosing ADHD
• Clinical examinations and questionnaires are important because of the
many controversial diagnosis of ADHD (Jackson & Farrugia, 1997(
• Medical and family history
– physical examination
– interviews with parents, the child, and child’s teacher
– behavior rating scales by parents and teacher
– observation of the child
– psychological tests (IQ, social and emotional adjustment, and
indication of learning disabilities(
• DSM-IV (1994( allows for adult diagnosis as long as the associative
characteristics are met...
9. Attention-Deficit
Hyperactivity Disorder
(ADHD( – DSM IV definition
Attention-Deficit Hyperactivity Disorder (ADHD)
is a neurobiological condition that characterized
by developmentally inappropriate level of
inattention (concentration, distractibility)
hyperactivity and impulsiveness that can occur
in various combinations across school, home,
and social settings.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text
Revision. Washington, DC, American Psychiatric Association, 2000.
15. Statistics
• Effects 3-5% of all school-aged children
• Most commonly diagnosed behavioral disorder in children
• 9-18% of school-aged children with mental retardation meet criteria for
ADHD (comorbidity is high in ADHD( (Epstein et al, 1986(
• Males to female ratio ranges from 4:1 to 9:1 depending on the setting (clinic
or general population( (DSM-IV, 1994(
16. Statistics
• Occurs in all cultures, with prevalent findings in Western cultures (due to
diagnostic methods( (DSM-IV(
• Mood and Anxiety, Learning, Substance-related, and Antisocial Personality
Disorders are more prevalent in family members of those with ADHD (high
rate of comorbidity( (DSM-IV(
• 9.5 million adults are suffering from ADHD (Quinn, 1997(
17. Why the Explosion in ADHD?
- Possible Explanations
1. We are better at finding and helping
children and adults who really do have
ADHD.
2.There are more children now who actually
have ADHD
18. Why the Explosion in ADHD?
- Possible Explanations
3.We have loosened the definition so more
kids are being diagnosed and treated.
4.We are actually diagnosing and treating
many children who don’t have ADHD, even
by a loosened definition.
20. Aetiology
• Heritability is the strongest factor in
development of ADHD
• Risk factors account for only a small portion of
variance
• Pregnancy variables: young maternal age,
maternal use of tobacco and alcohol, toxaemia,
post-maturity and extended labour
• Medical factors: fragile X syndrome, G6PD
deficiency, phenylketonuria, brain trauma, lead
poisoning, malnutrition
21. Main Neurotransmitters in ADHD
• Dopamine
• Noradrenaline
To regulate the inhibitory influences in
the frontal-cortical processing of
information
25. Associate symptoms with brain regions and
circuits that regulate them
HyperactiveHyperactive
symptomssymptoms
ImpulsiveImpulsive
symptomssymptoms
PrefrontalPrefrontal
motormotor
cortexcortex
OrbitalOrbital
frontalfrontal
cortexcortex
SelectiveSelective
attentionattention
SustainedSustained
attentionattention
problemproblem
solvingsolving
DorsalDorsal
ACCACC
DLPFCDLPFC
Stahl , 2008
26. Match neurotransmitters with circuits
DorsalDorsal
ACCACC
DLPFCDLPFC
HAHA
NENE DADA
AChACh
Selective attentionSelective attention Sustained attentionSustained attention
problem solvingproblem solving
•Little attention to detailLittle attention to detail
•Careless mistakesCareless mistakes
•Does not listenDoes not listen
•Loses thingsLoses things
•DistractedDistracted
•forgetfulforgetful
•Sustaining attentionSustaining attention
•follow through/finishfollow through/finish
•OrganizingOrganizing
•Avoids sustainedAvoids sustained
mental effortmental effortStahl , 2008
27. Aetiology
• ADHD symptoms and a diagnosis of ADHD may
themselves create interpersonal problems and
produce additional symptoms in the child
• Some children sensitive to
colourings/preservatives – not sugar per se
28. - Neurophysiological Factors:
Studies using PET have found lower cerebral blood flow
and metabolic rates in the frontal lobe areas of
children with ADHD than controls, pointing towards
frontal-striatal dysfunction.
- Psychosocial Factors:
Stressful psychic events, disruption of family
equilibrium and other anxiety provoking factors
contribute to the initiation or perpetuation of ADHD.
Etiology of ADHD
30. Inattention symptoms
• Fails to give close attention; careless mistakes
• Difficulty sustaining attention in tasks or play activities = requires
frequent redirection
• Does not seem to listen when spoken to directly
• Does not follow through on instructions; fails to finish task (not
oppositional or failure to understand
• Difficulty organizing tasks = homework poorly organized
• Dislikes sustained mental effort = schoolwork; homework
• Loses possessions
• Easily distracted
• Forgetful
31. Hyperactivity
• Fidgets
• Leaves seat when expected to sit
• Runs or climbs excessively
• Difficulty in playing quietly
• Often "on the go" or acts as if "driven by a motor"
• Often talks excessively
Perceived « immature »
Accidents/injuries prone
32. Impulsivity
• blurts out answers before questions
completed
• difficulty waiting turn
• interrupts or intrudes on others
Impatient
Rushing into things
Risk taking; Taking dares
33. DSM IV Criteria
A:
• 6 / 9 inattention
&/or
• 6 / 9 hyperactivity & impulsivity
= 6 months; maladaptive & inconsistent with development level
B: symptoms before age of 7
C: impairment in 2 settings
D: clinically significant – social/academic
E: not better explained by something else
34. A) Six or more of the following symptoms of inattention have been present for
at least 6 months to a point that is disruptive and inappropriate for
developmental level:
Inattention (CALL FOR FRED)
1) Often does not give close attention to details or makes Careless
mistakes in schoolwork, work, or other activities.
2) Often has trouble keeping Attention on tasks or play Activities.
3) Often does not seem to Listen when spoken to directly.
4) Often does not Follow instructions and Fails to finish schoolwork,
chores, or duties in the workplace (not due to oppositional behavior
or failure to understand instructions).
5) Often has trouble Organizing activities.
6) Often avoids, dislikes, or doesn’t want to do things that take a lot of
mental effort for a long period of time (such as schoolwork or
homework). Reluctant
7) Often Loses things needed for tasks and activities
(e.g. toys, school assignments, pencils, books, or tools).
8) Is often easily Distracted.
9) Is often Forgetful in daily activities.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text
Revision. Washington, DC, American Psychiatric Association, 2000.
Attention-Deficit/Hyperactivity Disorder
--Diagnostic Criteria
35. B) Six or more of the following symptoms of hyperactivity-impulsivity have
been present for at least 6 months to an extent that is disruptive and
inappropriate for developmental level:
Hyperactivity (RUNS FASTT)
1) Often fidgets with hands or feet or squirms in seat.
2) Often gets up from seat when remaining in seat is expected.
3) Often runs about or climbs when and where it is not appropriate
(adolescents or adults may feel very restless).
4) Often has trouble playing or enjoying leisure activities quietly.
5) Is often "on the go" or often acts as if "driven by a motor".
6) Often talks excessively.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text
Revision. Washington, DC, American Psychiatric Association, 2000.
Attention-Deficit/Hyperactivity Disorder
--Diagnostic Criteria
36. Impulsivity
7) Often blurts out answers before questions have been
finished.
8) Often has trouble waiting one’s turn.
9) Often interrupts or intrudes on others (e.g., butts into
conversations or games).
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text
Revision. Washington, DC, American Psychiatric Association, 2000.
Attention-Deficit/Hyperactivity Disorder
--Diagnostic Criteria
37. Based on these criteria, three types of ADHD are identified:
1) ADHD, Combined Type: if both criteria 1A and 1B are met for
the past 6 months.
2) ADHD, Predominantly Inattentive Type: if criterion 1A is met
but criterion 1B is not met for the past six months.
3) ADHD, Predominantly Hyperactive-Impulsive Type: if
Criterion 1B is met but Criterion 1A is not met for the past six
months.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision.
Washington, DC, American Psychiatric Association, 2000.
Attention-Deficit/Hyperactivity Disorder
--Diagnostic Criteria
38. Depending upon which symptoms predominate
DSM-IV-TR
recognized three subtypes of ADHD.
Combined subtype - 50% to 75%
Inattentive subtype - 20% to 30%
Hyperactive impulsive subtype - <15% cases
Subtypes of ADHD
39. 1.Infancy:
- More active, sleep less and cry much.
- Difficult to recognize until child achieves toddler age.
2.Preschool
- Motor restlessness, insatiable curiosity, vigorous and
destructive play ,demanding of parental attention
- Excessive temper tantrums.
- Decrease and/or restless sleep.
- Delays in motor and language development.
Clinical Features
41. 3.School age Children:
- Easily distracted.
- Difficulty in waiting for a turn.
- At home cannot be put off for even a minute.
- Often irritable.
- Emotionally labile – easily set off to laughter and tears.
- Mood and performance is variable and unpredictable.
- Impulsive- unable to delay gratification.
- Accident prone.
- Negative self concept and reactive hostility.
- 75% children show behavioral symptoms of aggression
and defiance.
- School difficulties both learning and behavioral coexist.
Clinical Features (cont…)
42. Scope of problem: school and
adolescence
• At least 10% of children under 18 years of age are or have
been affected by psychiatric disorders (12% of boys, 8% of
girls) - including ADHD, ASD, TS, CD, (and psychosis,
eating disorder, depression, and anxiety disorders)
• Another 10% or more are affected by various kinds of
psychosocial problems (including drug abuse), some of
which may be triggered by or interacting with ESSENCE
• About 5% are affected by “dyslexia”
• 1-2% are affected by LD
• Overlap/”Comorbidity”/Co-existence substantial
• When looking back: vast majority had symptoms <5 years
43. 4.Adolescents:
- Excessive motor activity.
- Discipline problems, family conflicts.
- Anger and emotional liability.
- Difficulty with authority.
- Significant lags in academic performance.
- Poor peer relationship.
- Poor self esteem.
- Speedy accidents.
- Delinquent children.
Clinical Features (cont…)
44. 5.Adults:
- Difficulty with concentration and performing
sedentary tasks.
- Disorganization.
- Forgetfulness.
- Failure to plan.
- Depending on others to maintain order.
- Trouble both getting started and ending tasks.
- Changing plans and jobs in midstream.
- Restlessness , impulsivity.
- Absent mindedness.
- Anti social acts.
Clinical Features (cont…)
45. Significance of InattentionSignificance of Inattention
for cognitive processesfor cognitive processes
Chhabildas, Pennington, Willcutt, J Abnorm Child Psychol, 2001Chhabildas, Pennington, Willcutt, J Abnorm Child Psychol, 2001
• Inattention symptom cluster is theInattention symptom cluster is the
strongest predictor of neuropsychologicalstrongest predictor of neuropsychological
impairmentsimpairments
– vigilance, processing speed, inhibitionvigilance, processing speed, inhibition
• Hyperactivity/impulsivityHyperactivity/impulsivity notnot associatedassociated
with neuropsychological impairmentswith neuropsychological impairments
46. Expert Rev Neurother , 2011
• Early detection and intervention may
prevent or ameliorate the development of
the disorder and reduce its long-term
impact.
47. DD
• Age appropriate behaviors in active
children,
• Intelligent children in under stimulating
environments eg classrooms,
• MR
• Psychiatric: ODD,CD, Anxiety disorders,
substance use disorders, PTSD, Mood
dis, PDD, LD
• Psychosocial: abuse/ neglect; poor
nutrition, chaotic family, bullied at school,
violent neighborhood
• Medical: Thyroid, heavy metal poisoning,
medications: sedating or activating
48. As many as one-third of
children diagnosed with
ADHD also have a co-
existing condition
49.
50. Comorbid DSM-IV Disorders
• Oppositional Defiant Disorder (40-70%)
ADHD contributes to and likely causes ODD.
• Conduct Disorder (20-56%)
• Delinquent/Antisocial Activities (18-30%)
Psychopathy – rates unknown but 20% of CD.
• Anxiety Disorders (10-40%; referral bias!)
Related to poor emotion regulation than to fear.
• Major Depression (0-45%; 27% by age 20)
Likely genetic linkage to ADHD.
• Bipolar Disorder (0-27%; likely 6-10% max.)
Not documented in any follow-up studies to date.
52. Oppositional Defiant Disorder
(ODD)
A pattern of negativistic, hostile and defiant behavior
lasting at least six months, during which four or
more of the following are present:
• Often loses temper.
• Often argues with adults.
• Often actively defies or refuses to follow adults rules.
• Often deliberately annoys people.
• Often blames others for his/her mistakes.
• Often is touchy / easily annoyed by others.
• Often is resentful.
• Often is spiteful / vindictive.
The disturbance in behavior causes significant impairment in social,
academic or occupational functioning.
53. Conduct Disorder
Repetitive and persistent pattern of behavior in
which the basic rights of others or major age
appropriate norms or rules of society are
violated.
• Aggression to people or animals.
• Destruction of property.
• Deceitfulness or theft.
• Serious violation of rules.
55. Prognosis
• 50% continue to suffer from clinically
significant symptoms
• Increased risk for substance use disorders
particularly if CD
• Low self esteem and poor social skills
56. Essential Concepts
• ADHD is a clinical diagnosis based on:
– Careful history taking
– Clinical examination
– Information from several sources & multiple settings (school, home& community)
• Hyperactivity does not need to be present during the mental state
exam to diagnose ADHD
• Concomitant learning disabilities & comorbid psychiatric disorders should
be evaluated
• Morbidity & disability often persist into adult life
• Children with ADHD have a higher injury rates, increased rate for CD
(1/3), criminal behavior, substance abuse, coordination deficits & other
psychiatric disorder (over 50%)
• There is increased risk for physical punishment, stress within the family
and economic cost to schools and criminal justice
57. ADHD Guideline Recommendations
1. The primary care clinician should initiate an
evaluation for ADHD for any child who
presents with academic or behavioral
problems and symptoms of inattention,
hyperactivity, or impulsivity. B/strong
recommendation
American Academy of Pediatrics
58. ADHD Guideline Recommendations
2. To make a diagnosis of ADHD, the primary
care clinician should determine that Diagnostic
and Statistical Manual of Mental Disorders,
Fourth Edition (DSM-IV) criteria have been met
(including documentation of impairment in
more than 1 major setting) with information
obtained primarily from parents/guardians,
teachers, and other school and mental health
clinicians involved in the child’s care. The
primary care clinician should also rule out any
alternative cause. B/strong recommendation
American Academy of Pediatrics
59. ADHD Guideline Recommendations
3. Evaluation of a child for ADHD should include
assessment for coexisting conditions, including
emotional, developmental, and physical.
B/strong recommendation
60. ADHD Guideline Recommendations
4. The primary care clinician should establish a
treatment program that recognizes ADHD as a
chronic condition and a child with ADHD as a
child/adolescent with special health care needs
who needs a medical home. B/strong
recommendation
61. Evaluation
Identify core symptoms.
Assess impairment.
Identify possible underlying or alternative
causes.
Identify co-occurring (co-morbid) conditions.
62. Assessment
• History – parents or caregivers,
− as well as a classroom teacher or other
school professional
• Interview of child
• Parent and teacher ratings of ADHD-related
behaviours
• Investigations - No clinical examination or lab tests
are accepted as either “rule in” or “rule out.”
Recommend vision & hearing tested
63. Overlap and issues
• Is ODD not a comorbidity but an index of
severity in ADHD?
• Are learning problems a result of non-assortative
mating in parents?
• Are DCD problems an index of a link with ASD?
• Is ASD a very common comorbidity signalling
some shared genes?
• Are ASD and ADHD in some cases on the same
spectrum?
64. Impact
Emotional
• Low self esteem
• Impaired self-regulation
• Relationship difficulties
Cognitive
• Organizing; planning and time management
• Learning delay
• Short term memory problems; lack of focus
• Language/speech
Physical
• Fine & gross motor skill delay
Behaviour
• Impaired self-regulation
67. Non-Pharmacological
Management
Diet
• Elimination diets – difficult
• Omega 3 – at least 1000mg/day for a month
Academic skills training: focus on following
directions, becoming organized, using time
effectively, checking work, taking notes
68. Non-Pharmacological Management
Behavioural therapy
- Does not reduce symptoms
– May improve social skills and compliance
– Does not lead to maintenance of gains or
improvement over time after the therapy is
completed
Social skills group
- Uses modelling, practice, feedback and
contingent reinforcement to address the social
deficits common in children with ADHD
- Useful for the secondary effects of ADHD,
such as low self-esteem, but not helpful for
core symptoms of ADHD
69.
70.
71. MEDICATIONS FOR ADHD
Stimulant Medications
–Methylphenidate (Ritalin, Ritalin
LA, Concerta)
–Dexamphetamine
Non-stimulant
Atomoxetine (Strattera)
Other
Clonidine (Catapres)
Risperidone (Risperdal)
72. MEDICATIONS FOR ADHD
Tricyclic Antidepressants
–Desipramine ;Imipramine (Tofranil)
Other Antidepressants
–Bupropion (Zyban); Fluoxetine
(Prozac)
73. Stimulants Specific Effects
• Improved sustained attention
• Reduced distractibility
• Improved short-term memory
• Reduced impulsivity
• Reduced motor activity
• Decreased excessive talking
• Reduced bossiness and aggression
with peers
74. Non-Stimulants
Atomoxetine is a highly specific norepinephrine
reuptake inhibitor.
Extended release guanfacine and clonidine are
alpha 2 adrenergic agents.
75. ADHD Guideline Recommendations
5. Recommendations for treatment of children
and youth with ADHD vary depending on the
patient’s age:
76. Preschool-aged Children
(4–5 Years of Age(
A. Prescribe evidence-based parent- and/or
teacher-administered behavior therapy as the
first line of treatment. A/strong
recommendation
and
May prescribe methylphenidate if the behavior
interventions do not provide significant
improvement and there is moderate-to-severe
continuing disturbance in the child’s function.
B/recommendation
77. Elementary School-aged Children
(6–11 Years of Age(
B. Prescribe FDA-approved medications for
ADHD. A/strong recommendation
and/or
Evidence-based parent- and/or teacher-
administered behavior therapy as treatment for
ADHD.
Preferably both. B/recommendation
78. Adolescents (12–18 Years of Age(
C. Prescribe FDA-approved medications for
ADHD with the assent of the adolescent.
A/strong recommendation
and
May prescribe behavior therapy as treatment for
ADHD. C/recommendation
Preferably both.
79. ADHD Guideline Recommendations
6. The primary care clinician should titrate doses
of medication for ADHD to achieve maximum
benefit with minimum adverse effects. B/strong
recommendation
80. How ADHD affects children or adolescents and their families.
Potential benefits associated with nonpharmacologic interventions
such as parental behavior therapy programs.
Potential benefits and adverse effects associated with
psychostimulants and nonstimulants.
Patient preferences regarding diagnosis and treatment options,
including pharmacologic and nonpharmacologic interventions.
How they can access information on ADHD about diagnosis and
treatment, educational programs, public benefits, and other issues.
What To Discuss With Your Patients
and Their Caregivers
Charach A, Dashti B, Carson P, et al. AHRQ Comparative Effectiveness Review No. 44. October 2011. Available at
www.effectivehealthcare.ahrq.gov/adhdtreatment.cfm.
81. Summary
Children from preschool age through
adolescent age can be diagnosed and treated
for ADHD.
Both medications (stimulants, selective
norepinephrine reuptake inhibitors and alpha
adreneric agents) and behavior therapy are
effective and safe treatments for ADHD.
Effective treatments require appropriate
titration and ongoing monitoring to remain
effective.
82. Effective Treatment of ADHD
Multidisciplin
e:
– Medical
– Psychological
– Educational
– Rehabilitation
The Team :
1.Consultant Child and Adolescent Psychiatrist
2.Clinical Psychologists
3.Occupational Therapists
4.Speech Therapists
5. Parents & Family
6. School officials
Editor's Notes
One of our most deeply held cultural values is that a child’s behavior is a reflection of how they were raised. It is a belief so deep that it is nearly instinctual. Example: Imagine yourself on the cereal aisle of the grocery store. A child is having a massive screaming, crying, kicking tantrum as he clutches a box of chocolate cocoa puffs. Now, how many of you, in your heart of hearts, have witnessed such a seen and have thought, “What a brat. Why doesn’t she do something.” Even though I know better, and even though I’ve heard countless moms of ADHD children tell me about having to abandon a half-full grocery cart, the thought still occurs to me. So, if a child is unruly, willful, a social misfit or a school drop-out, the parent must be to blame, particularly the mother. Psychiatric disorders in children have been variously attributed to lazy and inconsistent parenting, mothers working outside the home and divorce. The same sort of moral judgements are ascribed to affected children as well.. The commonly heard phrase, “He could do it if he wanted to”, sort of sums it all up. Here’s what we know. Kids with ADHD are difficult to parent, but their symptoms are not the result of inadequate parenting, or of even divorce or working outside the home. Denying the existence of psychiatric disorders in children is a reflection of the enormous stigma attached to mental illness.
The proponents of this idea view ADHD as a malignant social construct. ADHD is viewed as a social metaphor for our frenetic, competitive, conveyor belt of world. Tx therefore isn&apos;t about ameliorating impairment; it&apos;s about performance enhancement. It&apos;s about ambitious parents cultivating any advantage at the expense of medicating their children. It&apos;s about teachers and parents who want kids drugged and docile. It&apos;s about everyone and their brother looking for an excuse or an easy way out. These concerns are both true and false. There is evidence that the diagnosis of ADHD and it treatments have been misapplied. Most of the evidence is anecdotal; a physician named Lawrence Diller wrote an entire book about his clinical experiences entitled, &quot;Running on Ritalin&quot;. Alot of people point to the dramatic increase in office visits for ADHD and the accompanying prescription of stimulants following the inclusion of ADHD under the IDEA in 1991 as evidence of this social phenomena. Some people view the same &quot;Ritalin Explosion&quot; as indicative of rampant illicit use of stimulants. The reality is that many factors have contributed to increased prescribing of stimulants, which I will review in just a bit. There have been a few studies looking at regional prescribing practices
That is, if ADHD really existed, there would be an objective physical finding. The subjective nature of the diagnostic process in and off itself suggests that the disorder is an artificial construct or made up.
“where were these people when I was growing up?”
The pervasive sense that “we” in pediatrics and MH don’t really know what we are doing is fueled by reports of misdiagnosis, and particularly, overdiagnosis.
More controversy. I’d like to present a brief overview of the medical treatments of ADHD before discussing these myths.
Understanding what these medications are and how they work goes a long way in disabusing people of the notion that they are dangerous and addictive. It also provides a context for a discussion of the risk vs. the benefit of taking medication. Every medication - including any medication or herbal remedy you can purchase over the counter - presents a risk of side effects. The question is, what is the risk of not taking a medication, and do the negative effects outweigh the positive.
Atomoxetine has a high selectivity and affinity for the norepinephrine transporter.
It has little or no activity on other neurotransmitters.
The low affinity for other neuronal transmitters indicates a low potential for side effects associated with activity at these receptors.
References:
Michelson D, Faries D, Wernicke J, Kelsey D, Kendrick K, Sallee FR, Spencer T. Atomoxetine in the treatment of children and adolescents with attention-deficit/hyperactivity disorder: a randomized, placebo-controlled, dose-response study. Pediatrics 2001;108:E83. Available from: URL: http://www.pediatrics.org/cgi/content/full/108/5/e83.
Spencer T, Biederman J, Heiligenstein J, Wilens T, Faries D, Prince J, Faraone SV, Rea J, Witcher J, Zervas S. An open-label, dose-ranging study of atomoxetine in children with attention deficit hyperactivity disorder.J Child Adolesc Psychopharmacol 2001;11:251-265.
Kratochvil CJ, Bohac D, Harrington M, Baker N, May D, Burke WJ. An open-label trial of tomoxetine in pediatric attention deficit hyperactivity disorder. J Child Adolesc Psychopharmacol 2001;11:167-170.
What To Discuss With Your Patients and Their Caregivers
Things you should discuss with your patients and their caregivers regarding ADHD in children include:
How ADHD affects children and their families.
Potential benefits associated with nonpharmacologic interventions such as parental behavior therapy programs.
Potential benefits and adverse effects associated with psychostimulants and nonstimulants. In choosing medications, it is useful to discuss dose timing and monitoring to make choices most compatible with treatment goals and patient schedules and lifestyle.
Patient preferences regarding diagnosis and treatment options, including pharmacologic and nonpharmacologic interventions.
How they can access information from the National Resource Center on ADHD about diagnosis and treatment, educational programs, public benefits, and other issues. The Center is supported with funding from the Federal Government through the Centers for Disease Control and Prevention (CDC). ADHD information can be accessed online at www.help4adhd.org or by phone at 800-233-4050.
Reference:
Charach A, Dashti B, Carson P, et al. Attention Deficit Hyperactivity Disorder: Effectiveness of Treatment in At-Risk Preschoolers; Long-Term Effectiveness in All Ages; and Variability in Prevalence, Diagnosis, and Treatment. Comparative Effectiveness Review No. 44 (Prepared by McMaster University Evidence-based Practice Center under Contract No. MME 2202 290-02-0020). Rockville, MD: Agency for Healthcare Research and Quality; October 2011. AHRQ Publication No. 11(12)-EHC003-EF. Available at www.effectivehealthcare.ahrq.gov/adhdtreatment.cfm.