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Attention Deficit Hyperactivity Disorder PowerPoint Presentation

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Description : Check out this medical presentation on Pediatrics, which is titled "Attention Deficit Hyperactivity Disorder", to be able to differentiate and diagnose mild or marked ADHD, and other related mental/physical health problems.

Tags : Pediatrics, Attention Deficit Hyperactivity Disorder, ADHD, mental problems

Published on : Aug 03, 2021 | Views : 3223 | Downloads : 4

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Slide 1-

Tais S Moriyama, Aline C M Cho, Rachel E Verin, Joaquín Fuentes & Guilherme Polanczyk EXTERNALIZING DISORDERS Attention Deficit Hyperactivity Disorder Chapter D.1 Companion PowerPoint Presentation Adapted by Henrikje Klasen & Julie Chilton
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The “IACAPAP Textbook of Child and Adolescent Mental Health” is available at the IACAPAP website http://iacapap.org/iacapap-textbook-of-child-and-adolescent-mental-healthPlease note that this book and its companion powerpoint are:· Free and no registration is required to read or download it· This is an open-access publication under the Creative Commons Attribution Non- commercial License. According to this, use, distribution and reproduction in any medium are allowed without prior permission provided the original work is properly cited and the use is non-commercial.
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Differentiate and diagnose Mild or marked ADHD Other related mental/physical health problems Treat or manage through: Psycho-education Basic psycho-social interventions Pharmacotherapy Know when to refer patient to a specialist ADHDLearning Objectives
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ADHDGeneral Considerations Inattention, hyperactivity and impulsivity Two Diagnoses: ADHD (DSM) Hyperkinetic Disorder (ICD) Affects 3-5% of children Abnormal neuro-psychological functioning and neurobiological correlates Tree climbing (Vauvau, 2009)
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ADHDHistorical Note 1800’s Heinrich Hoffman “Impulsive Insanity” & “Defective Inhibition” Der Struwwelpeter, an illustrated book portraying children misbehaving (“Impulsive Insanity/Defective Inhibition”) by Heinrich Hoffman (1854).
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ADHDHistorical Note 1902 Lancet article 1920’s “minimal brain damage” 1930’s “hyperkinetische Erkrankung” 1960’s “minimal brain dysfunction” 1937 Benzedrine discovered Hyperkinetic Syndrome of Childhood” in ICD-9 1980 inattention recognized DSM-III Attention-Deficit Disorder with or without Hyperactivity
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ADHDIn Your World Relevance in your country? Tell us about your cases Do local people recognize ADHD? Is ADHD more of a problem in high income countries (HIC)? Are there any other points to discuss?
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ADHD Impact of ADHD in LAMIC vs. HIC Ahmed and Peter are both 7 years old and both have ADHD, combined type… listen to their story Ahmed lives in a small village in Africa. He goes to school in the mornings and plays or herds his father’s goats afterwards. Peter lives in a medium size town in Western Europe. He goes to school until 3 pm then usually plays football with his friends. How does ADHD impact their lives?
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ADHDImpact of ADHD: Education Listen to Ahmed and Peter’s experience at school... What will happen to Peter and Ahmed’s education after they have been expelled from 2nd year primary school?
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ADHDImpact of ADHD: Impulsivity/Distractibility Listen what happens when Ahmed and Peter get impulsive… Children with ADHD are accident prone. How will the broken leg impact on the lives of Peter and Ahmed? How long will it take to get help? What if an operation is needed?
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ADHDImpact of ADHD: Inattention/Forgetfulness Listen what happens, if Ahmed and Peter fail to pay attention and become forgetful… Children with ADHD are forgetful. How does the loss of something expensive impact on the lives of Peter and Ahmed? Will they be punished? How? Will it affect the family as a whole?
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ADHD Why Do You Need to Know? ADHD: Is common Can be serious Can persist Is stigmatizing Is treatable
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ADHD The Basics Core symptoms Inattention, hyperactivity, impulsivity Present in more than one context Leading to functional impairment Subtypes In DSM: combined, predominantly hyperactive, predominantly inattentive In ICD: Hyperkinetic disorder https://www.youtube.com/watch?v=GR1IZJXc6d8&feature=related
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ADHD Epidemiology Prevalence 6% for children 3% for adolescents Male>Female ADHD (DSM definition) > HKS (ICD definition)
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ADHD Differences According to Age Pre-school: play < 3mins, not listening, no sense of danger Primary school: activities < 10 mins, forgetful, distracted, restless, intrusive, disruptive Adolescence: attention< 30 mins, no focus/planning, fidgety, reckless Adult: incomplete details, restless, forgetful, impatient, accidents
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ADHD Course Some chronic Unclear persistence (Faraone 2006) 15% full persistence 40-60% partial remission Severe cases more persistent
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ADHD Associations with Durability of Symptoms Lower academic achievement Marital problems and dissatisfaction Divorce Difficulties dealing with offspring Lower job performance Unemployment Employment below potential Traffic accidents Other psychiatric disorders
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Strong genetic component (76%) Perinatal factors – some evidence Neurobiological deficits – growing evidence Deprivation and family factors – important for course and outcome Discuss: popular explanations in your cultural context? ADHD Etiology & Risk Factors
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Frontal-striatal dysfunction mediated by GABA modulated by catecholamines Catecholaminergic dysregulation Delay in cortical maturation ADHD Neurobiology
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ADHD Associated Features Defiant, aggressive antisocial behaviors Problems with social relationships IQ tends to be lower than in the general population Specific learning problems Co-ordination problems Specific developmental delay Poor emotional self-regulation
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ADHD Comorbid Disorders in Brazilian Community Samples
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ADHD Clinical Presentation/Diagnosis Inattention Hyperactivity Impulsivity Pervasive symptoms Duration/age of onset Impairment or distress *Diagnosis exclusively made on clinical grounds
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ADHD Clinical Assessment Information from at least two contexts Teachers are key Medical and psychiatric assessment Assess co-morbidity No additional tests necessary
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ADHD Neuropsychological Testing
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ADHD Differential Diagnosis Situational hyperactivity Behavioral disorders (ODD/CD) Emotional disorders Tics, chorea or other dyskinesias Misuse of substances Autism Spectrum Disorder Intellectual Disability *Frequent Comorbidity*
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ADHD Further Differential Considerations Parental mental health issues Severe marital discord or recent divorce Domestic violence Child abuse or neglect Severe bullying or exclusion by peers Severe deprivation or poverty
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ADHD Rating Scales SNAP IV: http://www.adhd.net/snap-iv-form.pdf SDQ : http://www.sdqinfo.org SWAN: http://www.adhd.net/SWAN_SCALE.pdf Many other proprietary (not free) scales
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28 ADHD Review of Assessment Algorithm Does the child have problems with inattention and over-activity? Are symptoms persistent, severe and causing impairment in the child’s functioning? Explore the impact of environmental stressors (e.g., family) Rule out medical or other conditions Consider ADHD if the answer to both is ‘yes’ Explore ways to address environmental stressor as part of management plan Manage or refer
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ADHD Aims of Treatment Individually tailored Reduce symptoms Improve educational outcomes Reduce family and school-based problems
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30 ADHD What works? Evidence Based Treatments: Best evidence for stimulant medication Behaviour treatments also effective in mild to moderate cases Psycho-education for parents and school
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ADHD Psychosocial Treatments Behavior therapy Individual, not always generalize Parent management training: particularly useful in younger children and for associated behavior problems School based: child in front of class, short tasks etc. Generally effective, but smaller effect size than medication First line treatment in younger children or milder cases
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ADHD Stimulant Medication Methylphenidate or Amphetamines Efficacy and safety well established ES 0.8-1.1; clinical response in 70% Dose: titrate for optimum response Short/long acting (sustained release) available NOT on WHO list of essential medicines Common side effects: nausea, weight loss, insomnia, agitation More serious side effects: tics, psychotic symptoms, raised blood pressure, growth retardation
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ADHD Stimulant Medication
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ADHD Non-Stimulant Medication Atomoxetine Clonidine Start dose 0.1mg at bedtime Add a.m. dose after 3-7 days, then midday dose after 3-7 days Increments by 0.05-0.1mg, max. 0.4mg Imipramine 2-3 times/day; 1-4mg/kg/day 30-50% response rate in 10 studies ECG recommended prior to treatment (cardiotoxicity) *Non-stimulants: less effective, more side effects, try only when stimulants not available, not tolerated or not appropriate*
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ADHD Interventions without Much Evidence Acupuncture Meditation Homeopathy Physical exercise Chiropractic care St. John’s wort Music therapy Bach flower remedies Elimination diets Hypericum perforatum “St. John’s Wort”
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ADHD Summary of Recommendations for Treatment
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Medication: ADHD If no response and severe impairment after pharmacological treatment combined with behavioral approaches Re-evaluate diagnosis and co-morbidity Check for undetected social adversity or abuse If still no response after 6 months consult with specialist ADHD When to Refer?
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Medication: ADHD AACAP ADHD Resource Center http://www.aacap.org/AACAP/Families_and_Youth/Resource Centers/ADHD_Resource_Center/Home.aspx NICE Guideline, Tools, and Resources http://www.nice.org.uk/guidance/cg72/resources ADHD Further Resources
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Medication: ADHD ADHD Thank You!