Attention Deficit Hyperactivity Disorder (ADHD)

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

2. Attention Deficit Hyperactivity Disorder, commonly referred to as ADHDOR often incorrectly as Attention Deficit Disorderor ADD

3. How common is ADHD? • 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. What is ADHD? • ADHD is a developmental disorder • mostly diagnosed during childhood, • particularly once school-going (pre-school or school) age is reached

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

6. How is a diagnosis of ADHD made? 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. Is ADHD related to other problems ? • ADHD often exists in conjunction with other behavioural disorders, learning or language problems and anxiety disorders

8. What causes of ADHD? • 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. What causes of ADHD? • 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 foetalhypoxia) • Prematurity • Malnutrition • Diet rich in additives and preservatives • Traumatic brain injury • Post traumatic stress disorder • Sensory integration disorders

10. What does a child with ADHD look like?

11. Signs of inattentiveness Inattentivenessto 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. Signs of Hyperactivity 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. Signs of Impulsivity 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. Impact of ADHD on the child’s functioning • 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. Management of ADHD • 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. Management of ADHD 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. Management of ADHD 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. Management of ADHD 3. Psychological therapies • Parent- and teacher interventions • Setting limits and explaining consequences for actions • Play therapy • Behavioural and family therapies Psychologist

19. Management of ADHD • 4. Neurodevelopmentalproblems 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)

20. References • 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.