Overview of ADHD (NH Edu-health )
-
Upload
wong-siew-lee-sherry -
Category
Documents
-
view
216 -
download
0
Transcript of Overview of ADHD (NH Edu-health )
-
7/30/2019 Overview of ADHD (NH Edu-health )
1/36
www.nheduhealth.com 2010 1
OVERVIEW OF ATTENTION
DEFICIT HYPERACTIVITYDISORDER (ADHD)
Dr. Nor Hamidah Mohd Salleh
Consultant PsychiatristM.D.,M.Med.(Psy)
-
7/30/2019 Overview of ADHD (NH Edu-health )
2/36
www.nheduhealth.com 2010 2
WHAT IS ADHD
ADHD is a developmental disorderof self control (executive function ofthe brain)
Symptoms arise from abnormalitiesin the brain
Their main problems are
Attention span Impulse control
Activity level
-
7/30/2019 Overview of ADHD (NH Edu-health )
3/36
www.nheduhealth.com 2010 3
WHAT IS ADHD
It is not caused by parental failureto discipline or control the child, andit it not a sign of some sort of
inherent badness in the child.
ADHD is a real disorder, a real
problem and often a real obstacle.It can be heartbreaking and nervewrecking.
-
7/30/2019 Overview of ADHD (NH Edu-health )
4/36
www.nheduhealth.com 2010 4
TYPES OF ADHD
1. PREDOMINANTLY HYPERACTIVEIMPULSIVE TYPE
A child must have six or more symptoms ofhyperactivity/impulsivity
2. PREDOMINANTLY INATTENTIVETYPE
A child must display six or more symptomsof inattention
3. COMBINED TYPE A child must show six or more symptoms
both of inattention and hyperactivity-impulsivity
-
7/30/2019 Overview of ADHD (NH Edu-health )
5/36
www.nheduhealth.com 2010 5
Symptoms of Inattention
Fails to pay close attention to details ormakes careless mistakes
Has difficulty maintaining attention in
tasks or play activities
Does not seem to listen when spoken todirectly
Does not follow directions and fails tocomplete schoolwork, chores, or, inadolescents, on the job duties
-
7/30/2019 Overview of ADHD (NH Edu-health )
6/36
www.nheduhealth.com 2010 6
Symptoms of Inattention
Has difficulty organizing tasks oractivities
Avoids or dislike task that requiresustained mental effort
Losses things necessary for task oractivities
Easily distracted
Often forgetful in daily activities
-
7/30/2019 Overview of ADHD (NH Edu-health )
7/36
www.nheduhealth.com 2010 7
Symptoms of Hyperactivity
Fidgets with hands or feet orsquirms in seat
Leaves seat in classroom or in othersituation in which remaining seatedis expected
Runs or climbs excessively when
inappropriate
-
7/30/2019 Overview of ADHD (NH Edu-health )
8/36
www.nheduhealth.com 2010 8
Symptoms of Hyperactivity
Has difficulty playing or engaging inleisure activities quietly
Always on the go or act as if drivenby a motor
Often talks excessively
In adolescence, may exhibit feelingof restlessness
-
7/30/2019 Overview of ADHD (NH Edu-health )
9/36
www.nheduhealth.com 2010 9
Symptoms of Impulsivity
Blurts out answers before questionshave been completed
Has difficulty waiting in turn Interrupts or intrudes on others (for
example butts into conversations orgames)
-
7/30/2019 Overview of ADHD (NH Edu-health )
10/36
www.nheduhealth.com 2010 10
WHATS WRONG WITH
ADHD CHILDREN
Research suggests that there is achemical imbalance affecting theneurotransmitters dopamine,norepineprine and serotonin.
An imperfection in the brain thatcauses the constant motion and
other intolerable behavioralproblems in ADHD.
-
7/30/2019 Overview of ADHD (NH Edu-health )
11/36
www.nheduhealth.com 2010 11
ADHD Diagnostic Evaluation
1. Physical examination
2. Parent-rated child behavior scales
3. Teacher-rated child behavior scales4. Parent and child interviews
5. Parent self report measures
-
7/30/2019 Overview of ADHD (NH Edu-health )
12/36
www.nheduhealth.com 2010 12
ADHD Diagnostic Evaluation
5. Parent self-report measures
6. Clinic-based psychological test
7. Review of prior school andmedical reports
8. Intelligence testing (IQ tests)and educational achievementtesting
-
7/30/2019 Overview of ADHD (NH Edu-health )
13/36
www.nheduhealth.com 2010 13
COEXISTING DISORDERS
1. Depressive disorder
2. Anxiety disorders
3. Learning disorders 4. Conduct disorder
5. Bipolar disorder
6. Oppositional defiant disorder
-
7/30/2019 Overview of ADHD (NH Edu-health )
14/36
www.nheduhealth.com 2010 14
Why we need to treat ADHD?
1. Neurobiological maturational delay that involvesthe brain executive and cognitive functions
2. A chronic condition that may extend into adulthood
3. The risks if untreated
1. Learning difficulties/disabilities2. Conduct disorder
3. Substance abuse disorder
4. Mood disorder
5. Poor work performance
6. Social problem7. Relationship problem
-
7/30/2019 Overview of ADHD (NH Edu-health )
15/36
www.nheduhealth.com 2010 15
When to start treatment?
Early identification and interventionis the best approach that helps toavoid or minimize the risks
Depending on the types andseverity of the ADHD
Early intervention program for
ADHD started as early as 3 yearsold.
-
7/30/2019 Overview of ADHD (NH Edu-health )
16/36
www.nheduhealth.com 2010 16
What to expect in treatment of
ADHD?
1. Pharmacotherapy
2. Behavior therapy/cognitive
behavior therapy3. Family therapy/guidance
1. Home management
2. Parenting and stress management
4. Classroom management
-
7/30/2019 Overview of ADHD (NH Edu-health )
17/36
www.nheduhealth.com 2010 17
What kind of treatment?
1. Early intervention program (EIP)
2. Middle childhood intervention
program (MCIP)3. Adolescent intervention program
(AIP)
4. Young Adult intervention program(YAIP)
-
7/30/2019 Overview of ADHD (NH Edu-health )
18/36
www.nheduhealth.com 2010 18
Early intervention program
1. Preschool children with ADHD/HKD
2. Assessment
1. Types or severity of ADHD (CPRS, CTRS)
2. Co morbidity e.g. speech delay, autistic disorder,
mental retardation, epilepsy3. Temperament
4. Parental awareness and support
5. IQ or general mental ability (WISC, KBIT, DTLA)
6. Speech, social and personal development
7. Quick neurological screening test8. Behavioral and emotional problem
9. Academic ability and placement (WRAT)
-
7/30/2019 Overview of ADHD (NH Edu-health )
19/36
www.nheduhealth.com 2010 19
Early Intervention Program
3. Rehabilitation1. Sensory motor integration program2. Speech therapy
4. Academic placement and support
1. Send them early (3-4 years old) to playschool which has sensory motordevelopmental program andtrained/empathic teacher
2. Special educational placement- private, NGOor public is recommended if the child has
learning disability3. Communicate with the school about the
childs developmental problem and establishteacher support program
-
7/30/2019 Overview of ADHD (NH Edu-health )
20/36
www.nheduhealth.com 2010 20
Early Intervention Program
5. Home management 8 steps to BetterBehavior
1. Learn to pay positive attention to your child
2. Use your powerful attention to gaincompliance
3. Give more effective commands
4. Teach your child not to interrupt youractivities
5. Set up a home token system6. Learn to punish misbehavior constructively
7. Expand your use of time out
8. Learn to manage your child in public places
-
7/30/2019 Overview of ADHD (NH Edu-health )
21/36
www.nheduhealth.com 2010 21
Middle Childhood Intervention
Program
1. Aims1. To improve
attention,behavior, moodand learning
2. To help developfurther the childsneurological,sensory, motor,social andpsychologicalmaturity
3. To provide parentalguidance andfamily therapy
-
7/30/2019 Overview of ADHD (NH Edu-health )
22/36
www.nheduhealth.com 2010 22
Middle Childhood Intervention
Program
2. Treatmentapproaches
1. Psychologicaltherapies
1. Behavior/Cognitivebehavior therapy
2. Focus therapy
3. Play therapy
4. Art therapy
5. Relaxation therapy
6. Anger
management7. Social group
therapy
-
7/30/2019 Overview of ADHD (NH Edu-health )
23/36
www.nheduhealth.com 2010 23
Middle Childhood Intervention
Program
3. Pharmacotherapy
3. Stimulant, non stimulant monitoring andmaintenance
4. Rehabilitation program
3. For child with delay maturity5. Academic placement and support
3. Consider special placement for children withmoderate to severe learning disability
4. Assess the childs learning aptitude and providesupport accordingly
5. Monitor the child academic progress andattainment
6. Psychological development reassessment yearly
7. Communicate with school about the childs needand behavioral strategies in learning
-
7/30/2019 Overview of ADHD (NH Edu-health )
24/36
www.nheduhealth.com 2010 24
Adolescent Intervention Program
1. Aims
1. To improveattention,behavior, mood
and learning2. To help develop
further the childspsychological andsocial maturity
3. To provide parentalguidance andfamily therapy
-
7/30/2019 Overview of ADHD (NH Edu-health )
25/36
www.nheduhealth.com 2010 25
Adolescent Intervention Program
2. Assessment2. Co morbidity such as conduct disorder, substance
abuse, mood disorder, adolescent-parent conflictand academic difficulties
3. The adolescents insight into her/his problem4. Parental awareness and support
3. Psychological therapies2. Individual psychotherapy
3. Group therapy
4. Anger management5. Relaxation therapy
6. Family therapy/guidance
-
7/30/2019 Overview of ADHD (NH Edu-health )
26/36
www.nheduhealth.com 2010 26
Adolescent Intervention Program
4. Pharmacotherapy1. Stimulants, non stimulants2. Monitoring, dose adjustment and
maintenance3. Consider tailing dose if the child reach
the maturity to cope on his/her own
5. Academic placement and support1. Monitoring of academic progress2.
Reassess the childs psychologicaldevelopment and learning aptitude3. Assess the child potential for future
vocation
-
7/30/2019 Overview of ADHD (NH Edu-health )
27/36
www.nheduhealth.com 2010 27
Young Adult Intervention Program
1. Aims1. To improve attention, behavior, mood and
learning
2. To enhance the young adults psychological,intellectual and social maturity
3. To guide them learn and cope effectively intheir chosen vocation
4. To provide parental guidance and familytherapy
5. To provide school guidance and/support
-
7/30/2019 Overview of ADHD (NH Edu-health )
28/36
www.nheduhealth.com 2010 28
Young Adult Intervention Program
2. Assessment
3. Psychological therapies
2. Cognitive behavior therapy
3. Supportive psychotherapy
4. Relaxation therapy
5. Individual psychotherapy
6. EEG biofeedback therapy
4. Medications5. Academic placement and support
-
7/30/2019 Overview of ADHD (NH Edu-health )
29/36
www.nheduhealth.com 2010 29
Who can treat ADHD?
Specialist with expertise in ADHD
Child and adolescent psychiatrist
Psychiatrist
Clinical psychologist
-
7/30/2019 Overview of ADHD (NH Edu-health )
30/36
www.nheduhealth.com 2010 30
Effective Treatment of ADHD
Multidiscipline
Medical
Psychological
Educational Rehabilitation
-
7/30/2019 Overview of ADHD (NH Edu-health )
31/36
www.nheduhealth.com 2010 31
Medical Treatment
Medication is used to treat thesymptoms and help the child withADHD function more effectively
Examples are
Ritalin, Stratera and Concerta
-
7/30/2019 Overview of ADHD (NH Edu-health )
32/36
www.nheduhealth.com 2010 32
Documented Specific Beneficial Effects
of Stimulants
I. MOTOR EFFECTS
Reduce activity to the level of normalpeers
Decrease excessive talking, noise anddisruption in the classroom
Improve hand writing
Improve the fine motor coordination
-
7/30/2019 Overview of ADHD (NH Edu-health )
33/36
www.nheduhealth.com 2010 33
Documented Specific Beneficial
Effects of Stimulants
II. SOCIAL EFFECTS Reduce anger
Reduce bossiness with peers
Reduce verbal and physical aggression withpeers
Reduce defiance and oppositional behaviorwith adults
Decrease intensity of behavior
Improve peer social status Improve ability to play and work independently
Improve mother-child and family interactions
-
7/30/2019 Overview of ADHD (NH Edu-health )
34/36
www.nheduhealth.com 2010 34
Documented Specific Beneficial Effects
of Stimulants
COGNITIVE EFFECTS
Improve sustained attention
Improve short term memory
Reduce distractibility
Reduce impulsivity
Increase the amount of academic work
completed Increase the accuracy of academic
work
-
7/30/2019 Overview of ADHD (NH Edu-health )
35/36
www.nheduhealth.com 2010 35
THE TEAM
Parents
Family
School officials
Health careprofessionals
-
7/30/2019 Overview of ADHD (NH Edu-health )
36/36
www nheduhealth com 2010 36
GIMC Child Developmental Team
1. Consultant Childand AdolescentPsychiatrist
2. ClinicalPsychologists
3. OccupationalTherapists
4. SpeechTherapists