1. Attention Deficit Hyperactivity Disorder (ADHD) Robyn Smith Department of Physiotherapy University Free State 2012

3. National Institute of Mental Health (NIMH) estimates that between 3-5% of pre-school or school aged children have ADHD e.g. Class of 35 children there will be 2 children will have ADHD Diagnosed 3-4 times more in boys than girls Estimated ADHD affects 4.1% adults aged 18 to 44 years

4. ADHD is a developmental disorder mostly diagnosed during childhood, particularly once school-going (pre-school or school) age is reached

5. ADHD is characterised by 3 key aspects: Inattention to the surrounding environment Hyperactivity Impulsivity Most children living with the disorder have a combination of these symptoms

6. A Diagnosis is made on the following basis: Symptoms must have been present ≤ 7 years of age Symptoms have to persist for at least 6 months Symptoms must be present in at least 2 different settings or environments e.g. home and at school Be inconsistent or abnormal for the child’s developmental level and age, Cause significant impairment in functioning and ADL

7. ADHD often exists in conjunction with other behavioural disorders, learning or language problems and anxiety disorders

8. 80% genetic or hereditary cause Most often runs in families Evidence suggests that the principle cause is genetic Type of ADHD that persists into childhood is more likely to have a strong genetic link

9. 20% non hereditary causes, including: Mother who uses alcohol and tobacco during pregnancy Mother exposed to abnormally high levels of lead during pregnancy (may lead foetal hypoxia) Prematurity Malnutrition Diet rich in additives and preservatives Traumatic brain injury Post traumatic stress disorder Sensory integration disorders

11. Inattentiveness to the point that it is disruptive or inappropriate for age: Often does not give close attention to details or makes careless mistakes in schoolwork. Often has trouble keeping attention on tasks or play activities. Often does not seem to listen when spoken to directly. Often does not follow instructions and fails to finish schoolwork or chores. Often has trouble organising activities. Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework). Often loses things needed for tasks and Is often easily distracted. Often forgetful in daily activities.

12. Hyperactivity to an extent that is disruptive and inappropriate for age: Often fidgets with hands or feet or squirms in seat. Often gets up from seat when remaining in seat is expected. Often runs around when and where it is not appropriate,and constantly seems restless. Often has trouble playing or enjoying leisure activities quietly. Is often "on the go" or often acts as if "driven by a motor". Often talks excessively.

13. Impulsivity to an extent that is disruptive and inappropriate for age: Often blurts out answers before questions have been finished. Often has trouble waiting one's turn. Often interrupts or intrudes on others (e.g. butts into conversations or games).

14. The lack of attentiveness, hyperactivity and impulsiveness significantly impairs their social and scholastic functioning. These children also often present with: Poor self esteem Seek immediate reinforcement (sensitive to rewards) Learning difficulties Perceptual problems Visual and spatial orientation problems Language deficits e.g. dyslexia and poor expressive language skills Physical difficulties may occur like “clumsiness”

15. There is no cure for ADHD but it can be treated effectively. ADHD often causes stress and anxiety, anger and frustration within the family and the entire family needs interdisciplinary support. Can involve multiple types of therapies over time

16. 1. Medication: Start between ages of 5 -7 years 2 main types medication used Ritalin = CNS stimulants Straterra monitor growth Anti- depressants Medication must be taken exactly as prescribed and should not suddenly be stopped. Regular follow up by a paediatrician advised.

17. 2. Diet Dietary adjustment helps in 5 % cases Reduce sugar intake Avoid colourants and preservatives in food Omega 3 and 6 fatty acid supplementation recommended (little scientific evidence though to support this...)

18. 3. Psychological therapies Parent- and teacher interventions Setting limits and explaining consequences for actions Play therapy Behavioural and family therapies Psychologist

19. 4. Neurodevelopmental problems Developmental delays need to be addressed by physiotherapists, occupational and speech therapists. Developmental delays need to be addressed by physiotherapists, occupational and speech therapists. Low tone Poor balance Poor coordination (Refer to DCD/ASD for treatment principles) Low tone Poor balance Poor coordination (Refer to DCD/ASD for treatment principles)

20. Venter, A. 2006. Attention Deficit Hyperactivity Disorder. New directions. Department of Paediatrics and Child Health (lecture notes unpublished) ADHD: reality not a myth. Information guide or booklet sponsored by Janssen-Cilag. MEDIHELP Medical Scheme. 2012. Living with ADHD information guide and video.