Transcript Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type

WEEK 13
ATTENTION DEFICIT
HYPERACTIVITY DISORDER
(ADHD)
Seven-year-old john’s mother is desperate for
help. “he walked at 10 months and has kept me
running ever since. As a child he was always
bouncing around the house and crashing into
things. He is inconstant motion, impulsive and
never listens. When I ask him to put his shirt in the
hamper, I find him playing with the shirt still on
the floor. John has no routines and seldom sleeps.
Discipline doesn’t work, nor do the techniques that
work for my other boys. He’s obviously to his
behavior. He could have a forbidden piece of cake
in his hand and deny ever taking. He never
finishes anything, and except for sitting down to
play a video game, rarely watches television
except on the run.”
John’s teacher says his main problems in
school are staying on task and keeping track of
what’s happening. “He blurts things out in
class and is constantly fidgeting or out of his
chair,” she says. Although John can complete
his assignments, he forget to brings to bring
home the book he needs to do his homework.
When he does complete his homework, he
forgets to put in his backpack or to hand it in.
John has great difficulty waiting his turn or
following rules with other children. Other kids
think he’s “weird” and don’t want to play with
him.
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Attention deficit hyperactivity disorder (ADHD)
describes children who display persistent ageinappropriate symptoms of inattention and
hyperativity-impulsivity.
ADHD can only be identified by characteristic
patterns of behavior, which vary quite a bit from
child to child.
The behavior of children with ADHD is a constant
sources of stress and frustration for the child and
parents, siblings, teachers and classmates.
A. Either 1 or 2
1)
Six (or more) of the following symptoms of inattention have persisted
for at least 6 months to a degree that is maladaptive and inconsistent with
developmental level:
Inattention
a) Often fails to give close attention to details or makes careless mistakes
in schoolwork, work, or other activities
b) Often has difficulty sustaining attention in tasks or play activities
c) Often does not seem to listen when spoken to directly
d) Often does not follow through on instructions and fails to finish
schoolwork, chores, or duties in the workplace (not due to oppositional
behavior or failure to understand instructions)
e) Often has difficulty organizing tasks and activities
f) Often avoids, dislikes, or is reluctant to engage in tasks that require
sustained mental effort (such as schoolwork or homework)
g) Often loses things necessary for tasks or activities (eg, toys, school
assignments, pencils, books, or tools)
h) Is often easily distracted by extraneous stimuli
i) Is often forgetful in daily activities
2) Six (or more) of the following symptoms of hyperactivity-impulsivity
have persisted for at least 6 months to a degree that is maladaptive and
inconsistent with developmental level:
Hyperactivity
a) Often fidgets with hands or feet or squirms in seat
b) Often leaves seat in classroom or in other situations in which
remaining seated is expected
c) Often runs about or climbs excessively in situations in which it is
inappropriate (in adolescents or adults, may be limited to subjective
feelings of restlessness)
d) Often has difficulty playing or engaging in leisure activities
quietly
e) Is often "on the go" or often acts as if "driven by a motor"
f) Often talks excessively
Impulsivity
g) Often blurts out answers before questions have been completed
h) Often has difficulty awaiting turn
i) Often interrupts or intrudes on others (eg, butts into conversations or
games)
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Attentional capacity
- is the amount of information we can remember
and attend for a short time
Selective Attention
- is the ability to concentrate on relevant stimuli
and not to be distracted by “noise” in the
environment.
Sustained Attention
- is the ability to maintain a persistent focus over
time or when fatigued.
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Cognitive impulsivity
- disorganization, hurried thinking and the
need for supervision
Behavioral Impulsivity
- calling out in class or acting without
considering the consequences.
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Not every child who displays inattentive, hyperactive
or impulsive behavior has ADHD. In order to diagnose
ADHD, these additional questions must be asked:
- Do the behaviors appear before age 7?
- Do they occur more often and with greater severity
than in other children of the same age and gender?
- Are they a persistent problem (for at least 6 month)?
- Do they occur across several settings and not only in
one location?
- Do they produce significant impairments in the
child’s social or academic performance?
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Predominantly Inattentive Type (ADHD-PI)
Predominantly Hyperactive-Impulsive Type
(ADHD)-HI)
Combined type (ADHD-C)
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Attention-Deficit/Hyperactivity Disorder,
Combined Type: if both criteria A1 and A2 are
met for the past 6 months
Attention-Deficit/Hyperactivity Disorder,
Predominantly Inattentive Type: if criterion
A1 is met but criterion A2 is not met for the
past 6 months
Attention-Deficit/Hyperactivity Disorder,
Predominantly Hyperactive, Impulsive Type:
if criterion A2 is met but criterion A1 is not met
for the past 6 months
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Besides their primary difficulties, children with
ADHD display other problems such as cognitive
deficits, speech and language impairments,
interpersonal difficulties and task and situational
factors.
Children with ADHD display deficits in executive
functions, the higher order mental processes that
underlie, the child’s capacity for self regulation.
Most children with ADHD are of normal
intelligence. Their difficulty is in applying their
intelligence to certain everyday life situation.
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Children with ADHD experience school performance
difficulties including lower grade, and more frequent
placement in special education class.
Many children with ADHD have a specific learning
disorder, typically in reading or math.
They often have language and speech impairment, and
also have difficulty using language in everyday
situations.
They may experience health related problems,
especially sleep disturbances, and are accident-prone.
They experience numerous interpersonal problems
with family members, teachers and peers
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Genetic influences
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Pregnancy, Birth and Early development
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Neurobiological Factors
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Diet, Allergy, and Lead
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Family Influences
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Stimulant Medication
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Parent Management Training
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Educational Intervention
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Family Counseling
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Support Groups
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Social Skill Training
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Cognitive Behavioral Self Control Training
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Individual Counseling