Transcript Attention Deficit and Hyperactive Disorders ppt

Attention deficit hyperactivity disorder (ADHD) is:
a neurological condition
that involves problems
with inattention and
hyperactivity-impulsivity
that are developmentally
inconsistent with the age
of the child.
Three Sub Types
Predominantly inattentive
Predominantly
hyperactive- impulsive
Combined
DSM V Criteria
(http://www.adhd-institute.com/assessment-diagnosis/diagnosis/dsm-5tm/ )
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A persistent pattern of inattention and/or hyperactivityimpulsivity that interferes with functioning or development
 Six or more of the symptoms have persisted for at least
six months to a degree that is inconsistent with
developmental level and that negatively impacts directly
on social and academic/occupational activities.
Please note: The symptoms are not solely a manifestation of
oppositional behaviour, defiance, hostility, or failure to understand
tasks or instructions. For older adolescents and adults (age 17 and
older), five or more symptoms are required
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Several inattentive or hyperactive-impulsive symptoms were
present prior to age 12 years
DSM V Criteria
(continued)
(http://www.adhd-institute.com/assessment-diagnosis/diagnosis/dsm-5tm/)
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Several inattentive or hyperactive-impulsive symptoms are
present in two or more settings (e.g. at home, school, or
work; with friends or relatives; in other activities)
There is clear evidence that the symptoms interfere with, or
reduce the quality of, social, academic or occupational
functioning
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The symptoms do not occur exclusively during the course of
schizophrenia or another psychotic disorder and are not
better explained by another mental disorder (e.g. mood
disorder, anxiety disorder, dissociative disorder, personality
disorder, substance intoxication or withdrawal)
GENERAL INFORMATION
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FIRST NOTICED BY MEDICAL SCIENCE IN
1902
ALL SOCIOECONOMIC, CULTURAL, AND
RACIAL BACKGROUNDS EFFECTED
80% SHOW NO SYMPTOMS IN DR. OFFICE
MOST ABOVE OR AVERAGE INTELLIGENCE
VERY INCONSISTENT IN PERFORMANCE AND
BEHAVIOR
PREVALENCE (CDC Statistics)
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Percent of Youth 4-17 Ever Diagnosed
with Attention-Deficit/Hyperactivity
Disorder by State: National Survey of
Children's Health
Boys 3 x more likely to be
diagnosed with ADHD.
GENERAL INFORMATION
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MORE OFTEN IN BOYS THOUGH GIRLS
OFTEN UNDER-IDENTIFIED
COMMON WITH OTHER DISORDERS
ABOUT 50% HAVE MOTOR PROBLEMS
1/3 TO 1/2 HAVE BLADDER CONTROL
PROBLEMS
40% CHILDREN WITH LD ALSO HAVE ADHD
20-25% WITH ADHD ALSO HAVE LD
MOST HAVE SYMPTOMS AS ADULTS
Co morbidity
65%
20-30%
of children with
ADHD will have a
co morbid condition
will also
suffer
depression
60%
of those with
Tourette’s Syndrome
have ADHD
50%
of youth with
Bipolar Disorder
have ADHD
50%
Of those with
Tourette’s Syndrome
have Obsessive
Compulsive Disorder
Other Co morbid Difficulties
Conduct
Disorders
Anxiety
Disorders
Drug Abuse
Obsessive
Compulsive
Disorder
Tourette’s
Syndrome
Sleep
Disorders
Oppositional
Defiant
Disorder
Learning
Disabilities
Additional Statistics
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30% never finish high school
43% of untreated ADHD aggressive boys
are arrested
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75% of those in prison have ADHD
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75% will have interpersonal problems
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2 - 4% of adult population have ADHD
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Medically untreated ADHD leads to an
increase in substance abuse as adults
Research findings
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Biological factors –
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Brain imaging research has shown
differences exist in brains of children
with and without ADHD
Genetic influences –
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Family History
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Identical Twin Studies
NEUROBIOLOGICAL DISABILITY
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IMBALANCE OF CERTAIN CHEMICALS
IN THE BRAIN:
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DOPAMINE
NOREPINEPHRINE
SEROTONIN
DECREASED ACTIVITY IN CERTAIN
AREAS OF THE BRAIN
CHRONIC – USUALLY LIFE LONG
Research does not support…
that these factors
lead to ADHD:
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Food additives
Sugar
Yeast
Poor child rearing
methods
Excessive television
viewing
A comprehensive evaluation
Behavioral
Component
includes
Educational
Component
Medical
Component
Behavioral evaluation
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Specific questionnaires and rating scales are used
to distinguish between children with and without
ADHD and quantify behavioral characteristics
Completed by different sources such as teachers
and parents
Observations of the child done in various settings
by a teacher, nurse, social worker, or psychologist
as well as rating scales can assist in diagnosing a
child
Medical Evaluation
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Assesses whether a child is manifesting symptoms of
ADHD regarding:
 Inattention
 Impulsivity
 Hyperactivity
Assesses the severity of these problems
Gathers information about other disabilities that may be
contributing to the child’s ADHD symptoms
Educational evaluation
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Assesses the extent to which the
symptoms of ADHD impact on the
academic performance in school
Includes:
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direct observations of the child
review of academic productivity
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assessment of completion of class work and
homework
both percentage of work completed and accuracy of
the work are considered
Treatment Options
Pharmacological
Approach
include
Behavioral
Approach
Multimodal
Approach
Pharmacological approach
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Medical profession prescribes meds – school staff need to monitor
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80% of students respond to treatment with stimulant meds
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May need to try various meds for best results
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All meds have side effects
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Not everyone experiences side effects
Often are temporary and subside after few weeks of treatment
Need to be reported to parents and doctors
Medications begin to work
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Antidepressants
4 – 6 weeks
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Stimulants
30 – 60 minutes
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Neuroleptics
2 – 4 weeks
may have some earlier
effect on certain
symptoms such as
aggression or sleep
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Mood stabilizers/anti- 3 – 6 weeks or longer
seizure medications
depending on dose
(need to obtain
therapeutic blood level)
Multimodal approach
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Multimodal treatment is a combined approach that includes the use of
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Medication
Educational Interventions
Behavioral Management
Training and Counseling for both parents and children
Results of NIMH Multimodal Treatment Study
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Compared four interventions – medication, behavioral intervention,
combination of medication and behavioral intervention, and nointerventioo community care
Found that combined medication/behavior intervention and medication
treatment were significantly better than behavioral therapy alone or
community care alone in reducing the symptoms of ADHD.
Found lower medication dosage is effective in multimodal treatment
Untreated ADHD Impact on School Performance
Core Features
Effects
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Inattention
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Hyperactivity
Impulsivity
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missing assignment details
miss information during lectures
assignment organization difficulty
verbal disruptions
physical disruptions
hurriedly respond to questions
make careless errors
Studies have found:
 lower average marks
 more failed grades
 more expulsions and suspensions
 increased dropout rates
 lower rate of college undergraduate completion
ANTIDEPRESSANTS
Examples:
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Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Mirtazapine (Remeron)
Imiprimine (Tofranil)
Bupropion (Wellbutrin)
Sertraline (Zoloft)
Paroxetine (Paxil) and
Venlafaxine (Effexor) are rarely
used in children due to recent
FDA warnings)
Side Effects:
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Dry mouth
Nausea
Vomiting
Headache
Excessive sweating
Weight gain/loss
Tremor
Constipation
Dizziness
Sedation
Nervousness
Diarrhea
STIMULANTS
Examples:
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Amphetamine/
Dextroamphetamine(Adderall)
Methylphenidate
hydrochloride
(Ritalin, Concerta-(long-acting)
Dexmethylphenidate (Focalin)
Metadate
Side Effects:
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Headache
Decreased appetite
Weight loss
Sleeplessness/insomnia
Motor tics
Palpitations
NON-STIMULANTS
Don’t cause agitation or sleeplessness  Side effects
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Are not controlled substances and
 Upset stomach
don’t pose the same risk of abuse or
 Decreased appetite, which
addiction
may cause weight loss
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Have a longer-lasting and smoother
 Nausea
effect than many stimulants, which
 Dizziness
can take effect and wear off abruptly
 Fatigue
 Atomoxetine HCl (Stratterra)
 Mood swings
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Mood stabilizers/anti-seizure
Side Effects:
Examples:
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Divalproex Sodium (Depakote)*
Lithium (Eskalith)*
Carbamazepine (Tegretol)*
Topiramate (Topomax)
Oxcarbazepine (Trileptal)
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* Need blood level monitoring
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Nausea
Vomiting
Hair loss
Weight gain
Tremor
Constipation
Diarrhea
Headache
Sedation
Acne
Rash
Bruising
Sleep problems
Blurred vision
Ringing in ears
Neuroleptics
(previously called anti-psychotics)
Examples: helping to restore
the balance of certain
natural substances in the
brain (neurotransmitters).
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Aripiprazole (Abilify)
Risperidone (Risperdal)
Quetiapine (Seroquel)
Olanzapine (Zyprexa)
Side Effects:
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Dry mouth
Headache
Weight gain
Constipation
Sedation
Anxiety
Agitation
Rapid heartbeat
Urination problems
Very low blood pressure
ANTI-hypertensives
Examples:
 Clonidine (Catapres) may be most
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beneficial in children with ADHD, who
are easily emotionally overwhelmed,
are anxious, and have a low
frustration tolerance
Guanfacine (Tenex or Intuniv)
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given .5mg BID. regulates levels of the
neurotransmitter norepinephrine; in the
prefrontal cortex of the brain, it decreases
sensitivity to distracting stimuli, and it
therefore may help with focus
Side Effects:
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Anxiety
Constipation
Dizziness
Drowsiness
Dry eyes/mouth
Fatigue
Headache
Decreased appetite
Nausea
Nervousness
Rash
ANTI-anxiety
Examples:
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Lorazepam (Ativan)
Clonazepam (Klonopin)
Diazepam (Valium)
Alprazolam (Xanax)
Usually doctors (child/adolescent psychiatrists) will
use anti-depressants to treat anxiety in children as
there is an increased risk of addiction and abuse in
using anti-anxiety medications (benzodiazepines).
We really have a lot more in common
with some of these people than we think!