Attention-Deficit /Hyperactivity Disorder (ADHD) Dr. Medhat shawkat 1

Definition of ADHD Attention-deficit/hyperactivity disorder describes children who display persistent age-inappropriate symptoms of inattention, hyperactivity, and impulsivity that are sufficient to cause impairment in major life activities. (American Psychiatric Association [APA], 2000) 2

DSM-IV Criteria for Diagnosis Six or more inattention symptoms or six or more hyperactivity-impulsivity symptoms Symptoms must be inconsistent with the child’s current developmental level Must persist to a degree that is considered maladaptive for at least six months 3

Additional DSM Criteria Some symptoms present before age 7 Impairment from symptoms must be present in at least two types of settings Clinically significant impairment in school, social or occupational functioning Symptoms do not occur solely during a pervasive developmental disorder or psychotic disorder Symptoms are not accounted for better by another mental disorder 4

Inattention 1.Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities. 2.Often has trouble keeping attention on tasks or play activities. 3.Often does not seem to listen when spoken to directly. 4.Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace 5.Often has trouble organizing activities. 6.Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time 7.Often loses things needed for tasks and activities 8.Is often easily distracted. 9.Is often forgetful in daily activities. 5

Hyperactivity 1.Often fidgets with hands or feet or squirms in seat. 2.Often gets up from seat when remaining in seat is expected. 3.Often runs about or climbs when and where it is not appropriate 4.Often has trouble playing or enjoying leisure activities quietly. 5.Is often "on the go" or often acts as if "driven by a motor". 6.Often talks excessively. 6

Impulsivity 1.Often blurts out answers before questions have been finished. 2.Often has trouble waiting one's turn. 3.Often interrupts or intrudes on others (e.g., butts into conversations or games). 7

Subtypes Predominantly Inattentive Type children who only meet the criteria for inattention Predominantly Hyperactive-Impulsive Type children who only meet the criteria for hyperactivity- impulsivity Combined Type children who meet the criteria for both inattention and hyperactivity-impulsivity 8

Prevalence: range from 1-10% of children under the age of 18 North American prevalence rate range from 3-5% Worldwide prevalence study: 5.29% Higher rates in North America Culture does have an impact on the prevalence of ADHD Higher prevalence rates when using teacher reports, lower prevalence rates when using parent reports Prevalence Rates 9

Facts In every classroom of 30 students, up to 3 children may have ADHD ADHD children tend to show emotional development that is 30% slower than children without the disorder Up to 65% of children with ADHD show problems with defiance, non- compliance, problems with authority figures, show verbal hostility, and have temper tantrums 40% of children with ADHD have at least one parent with the disorder 10

50% of children with ADHD display sleeping problems as well Parents of ADHD children are 3 times more likely to divorce than parents of non- ADHD children 75% of boys display the hyperactive-impulsive type of ADHD, while only 60% of girls are hyperactive Facts 11

Causes of ADHD ADHD is a medical disorder despite many myths early theories thought minor head injuries or brain damage were the cause the exact cause is currently unknown, but it is now thought to be caused by biological factors that influence neurological activity genetic influence toxins in the environment the use of drugs/alcohol during pregnancy environmental/family influence 12

Treatment A complete medical evaluation should be conducted The condition can be diagnosed when appropriate guidelines are used. The treatment of ADHD must involve a multimodal approach. 13

Medication Stimulant (most commonly used) Non-stimulant Antidepressants Antihypertensives Mood Stabilizers Neuroleptic drugs 14

Stimulant Medication Variety of forms: Methylphenidate Dextroamphetamine Amphetamine Lisdexamfetaime 15

For 80% of children with ADHD, Stimulants produce dramatic increases in: Sustained attention Impulsive control Persistence of work effort Decrease in task-irrelevant behavior Cooperation Physical Coordination 16

Behavior Therapies Parent Management Training (PMT) Parents are taught about ADHD Given guidelines for raising a child with ADHD For disruptive behavior parents are taught to use penalties Studies support PMT 17

Educational Interventions Focus on managing inattentive and hyperactive- impulsive behaviors Techniques are similar to those recommended to parents Reward system -Considerable support for school based interventions 18

Intensive Interventions Summer Treatment Programs Provided to children between 5-15 Classroom and recreational activates Advantages: peer relationships, and progress made during school year is not lost Used with medication, PMT, and Educational Interventions 19

Additional Interventions Family Counseling and Support Groups Helps everyone develop new skills, and attitudes, and teaches them how to relate more effectively Local and National support groups On-line bulletin boards Individual Counseling Teach children with ADHD how to feel better about one’s self Build strengths, cope with daily problems, and control attention and aggression 20

ADHD is equally common among boys and girls, and at all ages. ADHD is usually outgrown Children with ADHD are less intelligent Faulty parenting is the primary cause of ADHD Sugar ingestion is a primary cause of ADHD Common Myths About ADHD 21

ADHD rating scales follow the same standards for boys and girls. Due to the increase in prevalence rates and rise in prescriptions, ADHD is highly over-diagnosed ADHD symptoms often do not show up in the preschool years Private school is a better option for ADHD children Common Myths About ADHD 22

How We Can Help Providing management structure and routines for students can help combat some of the problems through the use of: Checklists of required materials Agenda to keep track of requirements Classroom routines to provide consistency for students "Learning how to learn" and study skills strategies that provide structures for completion of assignments Breaking assignments down into manageable parts that can be checked and reinforced Behaviour Plans: 1. One is more likely to succeed in changing behaviour by rewarding what is seen as desired behaviour than by punishing what is seen as undesirable behaviour 2. For a plan to work, the responses to acceptable and to unacceptable behaviours must be consistent and must occur each time. Inconsistent response patterns may reinforce the negative behaviour 23

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Faraone, V. S., Sergeant, J., Gillberg, C., & Bierderman, J. (2003). The worldwide prevalence of ADHD: is it an American condition? Retrieved October 20, 2008, from World Psychiatry Website: Mash, E., & Wolfe, D. (2005) Abnormal child psychology. Belmont: Thomson Learning Inc. Mitchell, B. (2006). ADHD self test. Retrieved October 22, 2008, from Curiosity Media Inc. Web site: Rief, S. (1998). The add/adhd checklist: an easy reference for parents & teachers. San Francisco: Jossey-Bass Schoenstadt, A. (2008). ADHD Treatment. Retrieved October 15, 2008, from (N.A.) Web site: Silver, L. B. (2004). Attention-deficit hyperactivity disorder: a clinical guide to diagnosis and treatment for health and mental health professionals. Washington: American Psychiatric Publishing, Inc. Stein, D. (1999). Ritalin is not the answer: A drug-free, practical program for children diagnosed with ADD or ADHD. San Francisco: Jossey-Bass Inc. Swierzewski, S. (2008) Attention-deficit hyperactivity disorder (ADHD). Retrieved October 15, 2008, from ( N.A. Web site: The Health Center. (2006). Child ADD/ADHD self test. Retrieved October 22, 2008, from The National Center for Health and Wellness Web site: Wender, P. H. (2001). Attention-deficit hyperactivity disorder in children, adolescents, and adults. New York: Oxford University Press. West, K. (2000). The Positive Side of ADD. Retrieved October 21, 2008, from Lesson Tutor Website: Wodrich, D. (2000). Attention deficit/hyperactivity disorder: What every parent wants to know. Baltimore: Paul H. Brooks Publishing Co. 25