Transcript Dr. Miriam Pizzani`s PowerPoint presentation on ADHD

Miriam K. Pizzani, MD
Source: Hyperactivity and Attention Disorders in Children
by Martin Baren, MD
Humor : The Complete Cartoons of The New Yorker
Edited by Robert Mankoff
Symptoms of an ADHD Child
With Hyperactivity
(impulsive)
 Is fidgety
 Leaves seat when shouldn’t
 Runs or climbs inappropriately
 Talks excessively
 Has difficulty playing quietly
 Is always on the go
 Blurts out answers
 Has trouble waiting turn
 Interrupts
Without Hyperactivity
(inattentive)
 Has difficulty following through on
instructions
 Has difficulty keeping attention on tasks
or play activities
 Loses things necessary for tasks and
activities at school and at home
 Doesn’t listen
 Fails to give close attention to details
 Seems disorganized
 Has trouble with tasks requiring long
term mental effort
 Is forgetful
 Is easily distracted
“Why take it so hard - there’s lot’s of other girls
in the world, aren’t there?”
“I know, but what am I going to do tonight?”
Myths about the Causes of ADHD
It is generally accepted that none of these cause ADHD- although some may
cause increased problems for a child with ADHD
 Too much sugar
 Television
 Too little sugar
 Florescent lighting
 Aspartame
 Video games
 Food sensitivity
 Food additives/coloring
“Well, stupid, don’t just sit there.”
Cautions
 If your child’s behavior does seem to change after a any
particular food or drink, make a note
 Try keeping the child off that substance, and see if
there is any improvement
 Gluten intolerance (wheat flour, rye ,barley -malt)
avoid for a 3 month trial
“What other bad words do you know?”
Why do some children develop ADHD while others do not?
Not all children who have inherited a tendency towards ADHD will develop
it. The following factors can make it more likely to emerge:
 Factors during pregnancy:
 Alcohol abuse
 Drug abuse
 Poor maternal nutrition
 Chemical poisons , like lead
 Factors after birth:
 Brain injuries during or after
birth
 Infections
 Iron deficiency anemia
 Chemical poisons, like lead
“Now can you hear me – you boys in the back?”
At what age does ADHD begin?
 Many parents are amazed that their children have ADHD,
because at home they noticed no difficulty. Indeed they
may report that the child can watch television or play video
games for hours, with no sign of attention disorder.
 How could such a child have ADHD?
 The answer is simple. Television and video games offer the
type of stimulation that helps these children to focus.
These passive situations, in which the children are actually
being stimulated from outside. In other words, attention
span during these types of tasks is not important for the
diagnosis.
“Sh, Darling.
Daddy’s afraid he’ll have to work in New Jersey!”
Previous Names For ADHD
 Postencephalitic Disorder
 Hyperkinetic Syndrome
 Minimal Brain Damage
 Minimal Brain Disorder
 Hyperkinetic Reaction
 Attention Deficit Disorder of Childhood (with or
without hyperactivity)
“Oh, she’s been acting that way all day.
Someone told her she looks like Katharine Hepburn.”
Important Factors During Diagnosis
 Explore all of the possibilities that could explain the
child’s behavior
 Find if there are any additional problems such as
learning disabilities, conduct disorders, depression,
anxiety, or various physical illnesses
 Know about the family structure, classroom situation,
and any special conditions or problems
 Have a good idea of the child’s thinking ability and
academic skills
Bully
Small Fry
Criminal Types
Peeping Tom
Sadist
Pyromania
c
Liar
Tattle-Tale
Cheat
The child’s therapy should always include help for classroom
problems. For example the teacher should:
 Write directions on the board
 Break instructions into small





steps
Have the child sit in front of
the class
Give more time for tests and
writing assignments
Remind the child to turn in
homework
Provide a structured learning
environment
Let the child use tape
recorders to record lessons
 Use simplified textbooks
 Tailor homework
assignments
 Ignore negative behavior as
much as possible
 Do not give bad marks for the
child’s work because of
difficulties caused by the
attention disorder
 Do not punish the child
because of difficulties arising
from lack of organization or
problems with attention
“Don’t just stand there – get witnesses!”
Managing the ADHD Child at Home
 Children usually look for some type of attention from
their parents- positive or negative. ADHD children
often get negative types of reinforcement. When
children do well, they should be encouraged and
rewarded. This is positive reinforcement. Be
positive with the ADHD child
 Tell the child often that he or she has a special problem
with concentration and impulse control. It’s helpful if
the children fully understand their condition and how
it affects them, both at school and at home.
“If this doesn’t get us in, nothing will.”
Managing the ADHD Child at Home
 Be very consistent in the way you treat your ADHD
child, and provide quite a bit of structure at any age.
This means that the children should always know
exactly how they stand in a certain situation, and how
far they can push, as well as what will happen if they
cross the line.
 Like all children, ADHD children do much better in
school if they eat a good, nutritious breakfast.
“We forgot to bring the children!”
What are the Benefits of Medication?
 More control over conduct, social behavior, impulsiveness,




and aggressive behavior
Improvement in attention span-especially in school
Dramatic improvements in the quality and quantity of
school work in general, including handwriting , finishing
tasks, the rate of accomplishment of certain academic
skills, and classroom behavior
Better relationships with peers and family members
Children will often become calmer, more organized, and
less stubborn. In addition to improvements in the way
they get along , there will be general increase in self esteem
“I’m sure Baby’s in here somewhere.”
Other Medications
Drug
Description
How it Works
Comments
Imipramine
Desipramine
Nortriptyline
Antidepressants
Improves the supply
of neurotransmitters
in the brain
Improve mood
Improvement in
impulsivity,
hyperactivity, and
attention
Bupropion
Antidepressant
Improves mood and
possibly attention.
Works on
neurotransmitters
Help for ADHD
symptoms – mostly
in adults
Adderall
Vyvanse
Amphetamines
Stimulates brain
neurotransmitters
Improvement in
impulsivity,
hyperactivity, and
attention
Other Medications
Drug
Description
How it Works
Comments
Thioridazine
Usually given for
severe emotional
problems
Can help behavioral
difficulties by
changing brain
chemistry
Useful in very small
children with ADHD
Lithium
Lithium is an
antimanic drug
Works on the brain
chemistry
Useful in calming
aggression in
children
Fluoxetine
Sertraline
Treats depression
in adults,
including
obsessivecompulsive
problems
Works on brain
neurotransmitters
Helpful in children
with attention
disorders who are
also depressed
In Summary
Once your child has been diagnosed by qualified professionals as having
ADHD, you will need to face the fact that the condition is unlikely to go
away. The good news, however, is that a great deal can be done to help
your child, particularly if you follow these guidelines:
 Work with health professionals to get the most
effective medical treatment
 Work with the school to get the most beneficial
classroom situation
 Know your child – understand what situations make
the condition worse
 Remember that with help, your child can grow up to be
a successful adult
“Of course it’s much too early to draw conclusions.
The Harvard entrance examinations will tell the story.”