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Understanding ADHD: Symptoms, Diagnosis & Treatment

Learn about ADHD, a neurological condition characterized by inattention and hyperactivity-impulsivity. Explore the DSM-V criteria, prevalence, co-morbidities, research findings, and treatment options.

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Understanding ADHD: Symptoms, Diagnosis & Treatment

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  1. a neurological condition that involves problems with inattention and hyperactivity-impulsivity that are developmentally inconsistent with the age of the child. Three Sub Types Predominantly inattentive Predominantly hyperactive- impulsive Combined Attention deficit hyperactivity disorder (ADHD) is:

  2. DSM V Criteria (http://www.adhd-institute.com/assessment-diagnosis/diagnosis/dsm-5tm/ ) • A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development • Six or more of the symptoms have persisted for at least six months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities. Please note: The symptoms are not solely a manifestation of oppositional behaviour, defiance, hostility, or failure to understand tasks or instructions. For older adolescents and adults (age 17 and older), five or more symptoms are required • Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years

  3. DSM V Criteria (continued)(http://www.adhd-institute.com/assessment-diagnosis/diagnosis/dsm-5tm/) • Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (e.g. at home, school, or work; with friends or relatives; in other activities) • There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic or occupational functioning • The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (e.g. mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal)

  4. GENERAL INFORMATION • FIRST NOTICED BY MEDICAL SCIENCE IN 1902 • ALL SOCIOECONOMIC, CULTURAL, AND RACIAL BACKGROUNDS EFFECTED • 80% SHOW NO SYMPTOMS IN DR. OFFICE • MOST ABOVE OR AVERAGE INTELLIGENCE • VERY INCONSISTENT IN PERFORMANCE AND BEHAVIOR

  5. PREVALENCE (CDC Statistics) • Percent of Youth 4-17 Ever Diagnosed with Attention-Deficit/Hyperactivity Disorder by State: National Survey of Children's Health • Boys 3 x more likely to be diagnosed with ADHD.

  6. GENERAL INFORMATION • MORE OFTEN IN BOYS THOUGH GIRLS OFTEN UNDER-IDENTIFIED • COMMON WITH OTHER DISORDERS • ABOUT 50% HAVE MOTOR PROBLEMS • 1/3 TO 1/2 HAVE BLADDER CONTROL PROBLEMS • 40% CHILDREN WITH LD ALSO HAVE ADHD • 20-25% WITH ADHD ALSO HAVE LD • MOST HAVE SYMPTOMS AS ADULTS

  7. Co morbidity

  8. Other Co morbid Difficulties

  9. Additional Statistics • 30% never finish high school • 43% of untreated ADHD aggressive boys are arrested • 75% of those in prison have ADHD • 75% will have interpersonal problems • 2 - 4% of adult population have ADHD • Medically untreated ADHD leads to an increase in substance abuse as adults

  10. Research findings • Biological factors – • Brain imaging research has shown differences exist in brains of children with and without ADHD • Genetic influences – • Family History • Identical Twin Studies

  11. NEUROBIOLOGICAL DISABILITY • IMBALANCE OF CERTAIN CHEMICALS IN THE BRAIN: • DOPAMINE • NOREPINEPHRINE • SEROTONIN • DECREASED ACTIVITY IN CERTAIN AREAS OF THE BRAIN • CHRONIC – USUALLY LIFE LONG

  12. Research does not support… that these factors lead to ADHD: • Food additives • Sugar • Yeast • Poor child rearing methods • Excessive television viewing

  13. Behavioral Component includes Educational Component Medical Component A comprehensive evaluation

  14. Behavioral evaluation • Specific questionnaires and rating scales are used to distinguish between children with and without ADHD and quantify behavioral characteristics • Completed by different sources such as teachers and parents • Observations of the child done in various settings by a teacher, nurse, social worker, or psychologist as well as rating scales can assist in diagnosing a child

  15. Medical Evaluation • Assesses whether a child is manifesting symptoms of ADHD regarding: • Inattention • Impulsivity • Hyperactivity • Assesses the severity of these problems • Gathers information about other disabilities that may be contributing to the child’s ADHD symptoms

  16. Educational evaluation • Assesses the extent to which the symptoms of ADHD impact on the academic performance in school • Includes: • direct observations of the child • review of academic productivity • assessment of completion of class work and homework • both percentage of work completed and accuracy of the work are considered

  17. Pharmacological Approach include Behavioral Approach Multimodal Approach Treatment Options

  18. Pharmacological approach • Medical profession prescribes meds – school staff need to monitor • 80% of students respond to treatment with stimulant meds • May need to try various meds for best results • All meds have side effects • Not everyone experiences side effects • Often are temporary and subside after few weeks of treatment • Need to be reported to parents and doctors

  19. Antidepressants Stimulants Neuroleptics Mood stabilizers/anti-seizure medications 4 – 6 weeks 30 – 60 minutes 2 – 4 weeks may have some earlier effect on certain symptoms such as aggression or sleep 3 – 6 weeks or longer depending on dose (need to obtain therapeutic blood level) Medications begin to work

  20. Multimodal approach • Multimodal treatment is a combined approach that includes the use of • Medication • Educational Interventions • Behavioral Management • Training and Counseling for both parents and children • Results of NIMH Multimodal Treatment Study • Compared four interventions – medication, behavioral intervention, combination of medication and behavioral intervention, and no-interventioo community care • Found that combined medication/behavior intervention and medication treatment were significantly better than behavioral therapy alone or community care alone in reducing the symptoms of ADHD. • Found lower medication dosage is effective in multimodal treatment

  21. Untreated ADHD - Impact on School Performance

  22. Examples: Citalopram (Celexa) Escitalopram (Lexapro) Fluoxetine (Prozac) Mirtazapine (Remeron) Imiprimine(Tofranil) Bupropion (Wellbutrin) Sertraline (Zoloft) Paroxetine (Paxil) and Venlafaxine (Effexor) are rarely used in children due to recent FDA warnings) Side Effects: Dry mouth Nausea Vomiting Headache Excessive sweating Weight gain/loss Tremor Constipation Dizziness Sedation Nervousness Diarrhea ANTIDEPRESSANTS

  23. Examples: Amphetamine/Dextroamphetamine- (Adderall) Methylphenidate hydrochloride(Ritalin, Concerta-(long-acting) Dexmethylphenidate (Focalin) Metadate Side Effects: Headache Decreased appetite Weight loss Sleeplessness/insomnia Motor tics Palpitations STIMULANTS

  24. NON-STIMULANTS • Don’t cause agitation or sleeplessness • Are not controlled substances and don’t pose the same risk of abuse or addiction • Have a longer-lasting and smoother effect than many stimulants, which can take effect and wear off abruptly • Atomoxetine HCl (Stratterra) • Side effects • Upset stomach • Decreased appetite, which may cause weight loss • Nausea • Dizziness • Fatigue • Mood swings

  25. Examples: Divalproex Sodium (Depakote)* Lithium (Eskalith)* Carbamazepine (Tegretol)* Topiramate (Topomax) Oxcarbazepine (Trileptal) * Need blood level monitoring Side Effects: Nausea Vomiting Hair loss Weight gain Tremor Constipation Diarrhea Headache Sedation Acne Rash Bruising Sleep problems Blurred vision Ringing in ears Mood stabilizers/anti-seizure

  26. Examples: helping to restore the balance of certain natural substances in the brain (neurotransmitters). Aripiprazole (Abilify) Risperidone (Risperdal) Quetiapine (Seroquel) Olanzapine (Zyprexa) Side Effects: Dry mouth Headache Weight gain Constipation Sedation Anxiety Agitation Rapid heartbeat Urination problems Very low blood pressure Neuroleptics (previously called anti-psychotics)

  27. Examples: Clonidine(Catapres) may be most beneficial in children with ADHD, who are easily emotionally overwhelmed, are anxious, and have a low frustration tolerance Guanfacine(Tenex or Intuniv) given .5mg BID. regulates levels of the neurotransmitter norepinephrine; in the prefrontal cortex of the brain, it decreases sensitivity to distracting stimuli, and it therefore may help with focus Side Effects: Anxiety Constipation Dizziness Drowsiness Dry eyes/mouth Fatigue Headache Decreased appetite Nausea Nervousness Rash ANTI-hypertensives

  28. Examples: Lorazepam (Ativan) Clonazepam (Klonopin) Diazepam (Valium) Alprazolam (Xanax) Usually doctors (child/adolescent psychiatrists) will use anti-depressants to treat anxiety in children as there is an increased risk of addiction and abuse in using anti-anxiety medications (benzodiazepines). ANTI-anxiety

  29. We really have a lot more in common with some of these people than we think!

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