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Attention Deficit Hyperactivity Disorder Judith Axelrod, M.D. Developmental-Behavioral Pediatrician Square One: Specialists in Child and Adolescent Development.

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Presentation on theme: "Attention Deficit Hyperactivity Disorder Judith Axelrod, M.D. Developmental-Behavioral Pediatrician Square One: Specialists in Child and Adolescent Development."— Presentation transcript:

1 Attention Deficit Hyperactivity Disorder Judith Axelrod, M.D. Developmental-Behavioral Pediatrician Square One: Specialists in Child and Adolescent Development

2 ADHD Attention 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 individuals 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%) – If parent has ADHDoffspring risk 20-54% – 25-30% of fathers – 15-20% of mothers – Identical twins 55-92% Child with ADHD – male sibling 35% – female sibling 15%

6 Core issues with ADHD Impulsivity Poorly regulated activityhyperactivity Distractibilitypoor sustained attention Disorganization Diminished rule governed behavior Emotional over arousal Poor/No generalization of information Variability of task performance

7 Pathology Pathology 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 disinhibition Dysfunction of cognitive ability Poor adaptive function Difficulty with rule governed behavior Delays in internalization of language

9 Other ADHD qualities Sometimes work harder at avoiding work than actually doing it Academic progress is often a roller coaster – up and down all year Moody Really do want to do well Frustration

10 Qualities: ADHD Inattentive Type (ADD) Often not identified until 5 th grade, middle school, or even high school May see substantial drop in grades around middle school Compensate for struggles (mask it) Often described as lazy, doesnt care, unmotivated, doesnt try Slower processing speed is common Often very quiet and well behaved – so not on the radar screen

11 Typical Vulnerabilities Low self esteem Humiliation Feeling dumb Always in trouble Quick to lie about behavior Become defensive Feel defeated

12 Differences in youth with ADHD: coping-temperament-subtypes ADHD with: – Anxiety – Obsessive Compulsive – Agitation – Mania – Defiance – Aggression – Mood reactivity

13 Strengths and Gifts Creative Charming Funny Social Sensitive and caring Hyperfocus Enthusiasm

14 Comorbid Conditions Learning Disabilities Cognitive Deficits Tics / Tourettes Disorder Drug or alcohol use

15 Comorbid Conditions Depression Anxiety Obsessive Compulsive Disorder Behavioral Disorders: Oppositional Defiant disorder Conduct Disorder

16 The Core Symptoms of ADHD are present as symptoms in a variety of psychiatric diagnoses

17 Other diagnoses with shared symptoms Depression Anxiety Bipolar Disorder Thought Disorder Autism Substance 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 evaluation Medical evaluation

22 Treatment Education Behavior Management/Family Counseling Medication Consultation with school personnel

23 Behavior Management/Family Counseling Effective in teaching ways to be consistent Teaching problem solving techniques Support Breaking cycles of learned behavior

24 Help in the Classroom Be sure you are dealing with ADHD Seek assistance to clarify diagnosis Communicate with teachers/parents Include the child in making a plan Ask the child what will help Help 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 dont meet basic goals for behavior) Remember all ADHD is NOT alike

26 Help in the Classroom Use a firm-flexibility approach with the child – combination of support, accommodations, clear limits, and expectations Daily schedules may help - visual Use visuals when possible Be cognizant of high risk times (e.g., unstructured, less supervised times)

27 Help in the Classroom Keep in mind that many behaviors may reflect coping with frustration/anxiety Structure and clear expectations are vital for success Need for cues, reminders, and repetition Be 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 Classroom Initiate communication with parents and ask about: – Homework time – Students understanding of tasks – Time and effort spent with routine homework

30 Help in the Classroom If the child is clearly falling behind, take the initiative to notify parents Be careful not to assume that problem behaviors are intentional Try to stay positive Work 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 saying Provide extended time as needed Emphasize quality over quantity with assignments and homework

32 Help in the Classroom: Distraction Have the student repeat directions and/or demonstrate understanding Monitor students progress in completing work so it doesnt pile up Provide 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 home Make sure the child has correctly recorded homework assignments Specifically request their homework and/or find a system that works Suggest simple ways to organize papers Work 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 tomorrow Note taking is often harder – be sure they have relatively complete notes Suggest 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 period Results Medication alone most effective treatment of core symptoms of ADHD Medication with psychosocial treatments was superior to other treatments for non-ADHD areas of functioning – i.e. aggressive behaviors, parent-child relations, teacher-rated social skills Medication Classes Stimulants Antidepressants Antihypertensives Wake-promoting agent used in narcolepsy

38 Stimulants First line medication treatment of ADHD Approximately 70% of children will respond to the first stimulant prescribed Up to 90% respond to the first or second stimulant attempted Mechanism of Action Increase dopaminergic and noradrenergic activity in frontal cortex

39 Stimulants Three types of stimulant formulations Short-acting Duration of action 2-4 hours Must be given 2-4 times per day Intermediate-acting Duration of action 6-8 hours Long-acting Duration of action hours Current accepted practice is to initiate treatment with an intermediate or long-acting preparation

40 Methylphenidate Class Short-acting Methylphenidate (Ritalin, Methylin) Focalin Intermediate-acting Ritalin LA/Ritalin SR Metadate CD/Metadate ER Long-acting Focalin XR Concerta Daytrana patch

41 Amphetamine Class Short Acting Adderall Abused in adolescent population Dexedrine/Dextrostat Desoxyn (Methamphetamine HCl) Intermediate-acting Dexedrine spansules Long Acting Adderall XR Vyvanse Prodrug – cleaved by stomach enzyme (less abusable)

42 Support CHADD (Children and Adults with Attention Deficit Disorders) 8181 Professional Place, Suite 201 Landover, MD

43 ADHD Parent Support Group LDA of Kentucky –

44 Educational Intervention

45 ADHD Recommeded Reading Barkley, Russell. Taking Charge of ADHD: The Complete Authoritative Guide for Parents, Fowler, M.C. (1990). Maybe You Know My Kid: A Parents 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: For Parents

46 ADHD Recommended Reading Nadeau, 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. For Adults

47 ADHD Recommended Reading Gehret, 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, Virginia Qujnn, P.O. and Stem, J.M. (1991). Putting on the Brakes: Young People's Guide to Understanding ADHD. New York: Magination Press. For Children

48 Square One Specialists in Child and Adolescent Development Developmental & Mental Health Specialists Comprehensive Evaluations In-depth Collaborative Treatment (502)

49 Multidisciplinary Staff Judith Axelrod, M.D. – Developmental Pediatrician David Causey, Ph.D. – Licensed Clinical Psychologist Lisa Ruble, Ph.D. – Licensed Psychologist Ann Hayes Ronald, M.Ed. – Licensed Psychological Associate Sherri Stover, M.S. L.C.S.W. – Licensed Clinical Social Worker Ashley Redenbaugh, M.S. CCC-SLP – Speech Language Pathologist 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.

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