Presentation on theme: "Attention Deficit Hyperactivity Disorder"— Presentation transcript:
1 Attention Deficit Hyperactivity Disorder Judith Axelrod, M.D.Developmental-Behavioral PediatricianSquare One: Specialists in Child and Adolescent Development
2 ADHDAttention Deficit Hyperactivity Disorder (ADHD) is a chronic neurodevelopmental disorder
3 Attention Deficit Hyperactivity Disorder The diagnosis of Attention Deficit Hyperactivity Disorder is given to individuals who have frequent failure to comply in an age appropriate fashion with situational demands for inhibition of impulsive responses and resistance to distracting influences. These behaviors interfere with the individual’s performance in social and academic settings.
4 ADHD: Current Working Theory Symptoms of ADHD are caused by abnormality in the Executive Function of the brain.
5 ADHD and Inheritance Inherited 57-97% (mean 80%) Child with ADHD If parent has ADHD—offspring risk 20-54%25-30% of fathers15-20% of mothersIdentical twins 55-92%Child with ADHDmale sibling 35%female sibling 15%
6 Core issues with ADHD Impulsivity Poorly regulated activity—hyperactivityDistractibility—poor sustained attentionDisorganizationDiminished rule governed behaviorEmotional over arousalPoor/No generalization of informationVariability of task performance
7 PathologyPathology occurs when the core symptoms of ADHD are pervasive, prominent and impair functioning in all aspects of life.
8 What is it like to have ADHD Behavioral disinhibitionDysfunction of cognitive abilityPoor adaptive functionDifficulty with rule governed behaviorDelays in internalization of language
9 Other ADHD qualitiesSometimes work harder at avoiding work than actually doing itAcademic progress is often a roller coaster – up and down all yearMoodyReally do want to do wellFrustration
10 Qualities: ADHD Inattentive Type (“ADD”) Often not identified until 5th grade, middle school, or even high schoolMay see substantial drop in grades around middle schoolCompensate for struggles (mask it)Often described as “lazy”, “doesn’t care”, “unmotivated”, “doesn’t try”Slower processing speed is commonOften very quiet and well behaved – so not on the “radar screen”
11 Typical Vulnerabilities Low self esteemHumiliationFeeling “dumb”Always “in trouble”Quick to lie about behaviorBecome defensiveFeel defeated
12 Differences in youth with ADHD: coping-temperament-subtypes ADHD with:AnxietyObsessive CompulsiveAgitationManiaDefianceAggressionMood reactivity
13 Strengths and “Gifts” Creative Charming Funny Social Sensitive and caringHyperfocusEnthusiasm
14 Comorbid Conditions Learning Disabilities Cognitive Deficits Tics / Tourette’s DisorderDrug or alcohol use
16 The Core Symptoms of ADHD are present as symptoms in a variety of psychiatric diagnoses
17 Other diagnoses with shared symptoms DepressionAnxietyBipolar DisorderThought DisorderAutismSubstance abuse
18 Children with Attention Deficit Hyperactivity Disorder frequently have social skill difficulties which are manifested by intrusive behaviors and erratic or variable behaviors. They can be demanding and controlling. Maturity seems to lag and these children are often perceived as two years behind their aged peers in maturity.
19 30-40% of children with Attention Deficit Hyperactivity Disorder have affective disorders such as depression and anxiety
20 How is the Diagnosis of Attention Deficit Hyperactivity Disorder made?
21 To make the diagnosis of ADHD Psychological evaluationMedical evaluation
22 Treatment Education Behavior Management/Family Counseling Medication Consultation with school personnel
23 Behavior Management/Family Counseling Effective in teaching ways to be consistentTeaching problem solving techniquesSupportBreaking cycles of learned behavior
24 Help in the Classroom Be sure you are dealing with ADHD Seek assistance to clarify diagnosisCommunicate with teachers/parentsInclude the child in making a planAsk the child what will helpHelp the child to take ownership
25 Help in the Classroom Avoid being punitive Set positive goals Attempt to reinforce effort and not just accomplishment of goals (sometimes these children try their best and still don’t meet basic goals for behavior)Remember all ADHD is NOT alike
26 Help in the ClassroomUse a “firm-flexibility” approach with the child – combination of support, accommodations, clear limits, and expectationsDaily schedules may help - visualUse visuals when possibleBe cognizant of “high risk” times (e.g., unstructured, less supervised times)
27 Help in the ClassroomKeep in mind that many behaviors may reflect coping with frustration/anxietyStructure and clear expectations are vital for successNeed for cues, reminders, and repetitionBe aware of and avoid “helping” strategies that may humiliate the child
28 Help in the Classroom:ANY approach one takes should strive to minimize penalizing the student for struggles that are a direct result of ADHD. That is, attempt to differentiate behaviors that are much harder for the child due to ADHD versus those that may occur by choice
29 Help in the ClassroomInitiate communication with parents and ask about:Homework timeStudent’s understanding of tasksTime and effort spent with routine homework
30 Help in the ClassroomIf the child is clearly falling behind, take the initiative to notify parentsBe careful not to assume that problem behaviors are intentionalTry to stay positiveWork with the student to set goals (but not too many at once)
31 Help in the Classroom: Distraction Remember a child may be “listening” to you but not attending to what you are sayingProvide extended time as neededEmphasize quality over quantity with assignments and homework
32 Help in the Classroom: Distraction Have the student repeat directions and/or demonstrate understandingMonitor student’s progress in completing work so it doesn’t pile upProvide cues to help the child stay on task (e.g., agree on “secret” cues)
33 Help in the Classroom: Disorganization Consider allowing the student to have a second set of books at homeMake sure the child has correctly recorded homework assignmentsSpecifically request their homework and/or find a system that worksSuggest simple ways to organize papersWork with the child to organize locker
34 Help in the Classroom: Hyperactivity/Impulsivity Provide adequate breaks and opportunities to move or “reset”Use visual cues to help the child remember to “STOP & THINK”When entering into a “high risk” situation, talk through successful behavior with the student beforehand
36 Help in the Classroom: Working Memory A skill learned today is not necessarily remembered tomorrowNote taking is often harder – be sure they have relatively complete notesSuggest strategies that help the child compensate for this weakness
37 ADHD Treatment Multimodal Treatment Study of ADHD (n = 579) Investigated effects of various treatment modalities on children with ADHD, combined type over 14 month periodResultsMedication alone most effective treatment of core symptoms of ADHDMedication with psychosocial treatments was superior to other treatments for non-ADHD areas of functioning – i.e. aggressive behaviors, parent-child relations, teacher-rated social skillsMedication ClassesStimulantsAntidepressantsAntihypertensivesWake-promoting agent used in narcolepsy
38 Stimulants First line medication treatment of ADHD Mechanism of Action Approximately 70% of children will respond to the first stimulant prescribedUp to 90% respond to the first or second stimulant attemptedMechanism of ActionIncrease dopaminergic and noradrenergic activity in frontal cortex
39 Stimulants Three types of stimulant formulations Short-actingDuration of action 2-4 hoursMust be given 2-4 times per dayIntermediate-actingDuration of action 6-8 hoursLong-actingDuration of action hoursCurrent accepted practice is to initiate treatment with an intermediate or long-acting preparation
41 Amphetamine Class Short Acting Intermediate-acting Long Acting AdderallAbused in adolescent populationDexedrine/DextrostatDesoxyn (Methamphetamine HCl)Intermediate-actingDexedrine spansulesLong ActingAdderall XRVyvanseProdrug – cleaved by stomach enzyme (less abusable)
42 Support CHADD (Children and Adults with Attention Deficit Disorders) 8181 Professional Place, Suite 201Landover, MD 20785
45 ADHD Recommeded Reading For ParentsBarkley, Russell. Taking Charge of ADHD: The Complete Authoritative Guide for Parents,Fowler, M.C. (1990). Maybe You Know My Kid: A Parent’s Guide to Identifying, Understanding, and Helping Your Child with Attention-Deficit Hyperactivity Disorder. New York: Carol.Hallowell. Edward and Ratey, John, Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder From Childhood through Adulthood. Patheon Books.Hallowell. Edward and Ratey, John, Delivered from Distraction: Getting the most out of Life with Attention Deficit Disorder. Patheon Books.Jensen, Peter. Making the System Work For Your Child with ADHD. Guilford Press.Ingersoll, B. (1988). Your Hyperactive Child. New York: Doubleday.Ingersoll, B. and Goldstein, S. (1993). Attention Deficit Disorder and Learning Disabilities, New York: Doubleday.Nadeau, K. A Survival Guide for High School and College Students with ADHD, New York: Magination.Honos-Webb, Lara. The Gift Of ADHD: How To Transform Your Child's Problems Into Strengths. Oakland: New Harbinger.Taylor, Blake. ADHD and Me: What I Learned from Lighting Fires and the Dinner Table. New Harbinger: 2008.
46 ADHD Recommended Reading For AdultsNadeau, K. A Survival Guide for High School and College Students with ADHD, New York: Magination.Kelly, K. and Ramundo, P. (1993), You Mean I'm Not Lazy. Stupid. or Crazy?! Cincinnati: Tyrell and Jerem Press.Murphy, K. and LeVert, S. (1995). Out of the Fog: Treatment Options and Coping Strategies for Adult Attention Deficit Disorder. New York: Hyperion.Quinn, P.O. (1994). ADD and the College Student: a Guide for High School and College Students with Attention Deficit Disorder. New York: Magination.
47 ADHD Recommended Reading For ChildrenGehret, J. (1991). Eagle Eyes: a Child's Guide to Paying Attention. Fairport, NY: Verbal Images Press.Gordon, M. (1992), My Brother's a World-Class Pain: A Sibling's Guide to ADHD/Hyperactivity. DeWitt, NY: GSI Publications.Nadeau, K.G. and Dixon, E.B. (1991), Learning to Slow Down and Pay Attention.Chesapeake Psychological Services, 5041 A&B Backlick Road, Annandale, VirginiaQujnn, P.O. and Stem, J.M. (1991). Putting on the Brakes: Young People's Guide to Understanding ADHD. New York: Magination Press.
48 Square One Specialists in Child and Adolescent Development Developmental & Mental Health SpecialistsComprehensive EvaluationsIn-depth Collaborative Treatment(502)
49 Multidisciplinary Staff Our team of doctors and specialists are experts in child & adolescent development. More importantly, they are people who love to help children—who want nothing more than to see them succeed in everything they do. Regardless of what makes your child unique, you can trust that our staff has the expertise to help them reach their maximum potential.Judith Axelrod, M.D.Developmental PediatricianDavid Causey, Ph.D.Licensed Clinical PsychologistLisa Ruble, Ph.D.Licensed Psychologist Ann Hayes Ronald, M.Ed.Licensed Psychological AssociateSherri Stover, M.S. L.C.S.W. Licensed Clinical Social Worker Ashley Redenbaugh, M.S. CCC-SLPSpeech Language Pathologist