Attention Deficit / Hyperactivity Disorder (ADHD) - PowerPoint Presentation

Slide1

Attention Deficit / Hyperactivity Disorder (ADHD)

Common Symptoms, Differential Diagnoses, and Treatment Options

Dr

. Rachel Andaloro

Metrowest

Neuropsychology

ASHPAC

meeting 3/17

Slide2

ADHD

One of the most common childhood

disorders

ADHD

affects about 9% of American children from 13-18 and about 4.1% of

adults

Average age of onset is 7 years of age

Boys

are four times more likely to be diagnosed than girls

The number of kids being diagnosed with ADHD is

increasing

Slide3

DSM-V ADHD Criteria

Persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development

Inattention: (≥6 of following symptoms have persisted for at least 6 months; for >17 years ≥ 5 are required)

Fails to give close attention to details

Difficulty sustaining attention in tasks or play activities

Does not seem to listen when spoken to directly

Often does not follow through

Slide4

DSM-V Criteria cont.

(Inattention)

Difficulty organizing tasks and activities

Often avoids/dislikes/reluctant to engage in tasks that require sustained mental effort

Often loses things necessary for tasks and activities

Often distracted by extraneous stimuli

Often forgetful in daily activities

Slide5

DSM ADHD Criteria cont.

2) Hyperactivity/Impulsivity: (≥ 6, for >17 at least 5)

Often fidgets, squirms in seat

Often leaves seat

Often runs about or climbs

Often unable to engage in leisure activities quietly

Often on the go

Often talks excessively

Often blurts out an answer

Often has difficulty waiting his or her turn

Often interrupts or intrudes on others

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ADHD Criteria cont.

Several symptoms were present < age of 12

Symptoms are present in

two or more

settings

S

ymptoms interfere with social, academic, or occupational functioning

Symptoms are not better explained by another mental disorder (*mood disorder, anxiety, personality disorder, psychotic disorder, substance intoxication or withdrawal)

Can be combined presentation if both domains are met or predominantly inattentive presentation if criterion 2 are not met or vice versa

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Neuropsychological Assessment

ADHD is diagnosed based on these criteria

But, it can be difficult to tease out other possible etiologies without a thorough evaluation.

Neuropsychological evaluation provides a thorough assessment of history as well as a broad measurement

of

overall cognitive functioning

Slide8

ADHD and cognition

ADHD is associated with deficits in

executive functioning

Executive functions affect many aspects of behavior

Determine our development

of strategies to approach, plan, or carry out

cognitive

tasks, monitor or regulate behavior

Measure a

broad

range of cognitive functions, with emphasis on measures of executive skills

Slide9

Other Possible Etiologies…

NP

eval

is i

mportant

in ruling in or out other disorders

Depression and anxiety - associated with deficits in executive functioning, and can present with similar symptoms

Underlying mood disorder?

Other health

issues?

Lyme

Disease

Obtaining a thorough history is key in teasing these apart.

Slide10

Comorbidities

ADHD is often

comorbid

with other mental health disorders:

Oppositional Defiant Disorder

Conduct Disorder

Autism Spectrum Disorders

Learning Disabilities

If co-morbid with LD, ADHD symptoms may be masking the LD (or LD may cause inattention)

Slide11

Treatment

Options for treatment:

Behavioral interventions first

Medication as a last resort

Slide12

Medications

70% improve with use

Amphetamines (Adderall,

Dexedrin

)

Methylphenidate (Concerta,

Metadate

, Ritalin)

Strattera

(non-stimulant option)

Clonidine and

guanfacine

(

Intuniv

):

nonstimulant

medicines approved to treat aggression and impulsivity not controlled by other ADHD medicines.

Antidepressants (Vyvanse,

Wellbutrin

)

Slide13

Medications cont.

Stimulants may be related to slower growth in children. Most children seem to catch up in height and weight by the time they are adults.

(medication holidays)

Stimulants can be abused

Can cause sleep disturbance

Research has shown that these medicines, when taken correctly, don't cause dependence.

Slide14

Behavior Modification for ADHD

Preferential seating, additional time, separate room for quizzes and tests

Be on time, sit in the front row (limits distractions)

Work

with ADHD coach, mentor / advisor to help establish a plan and organizational strategy

Frequent, brief contact with mentor

Audio

record lectures- can be replayed in order to review missed information

Continuous note-taking to increase attention to lectures

Work closely with more organized students

Attend after-class help sessions whenever possible

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Behavior Modification cont.

Provide simple instructions and repeat if necessary.

Have child repeat information/ instructions back in their own words, to ensure understanding

Gentle and repeated prompting/reminders to engage in tasks/remain on-task

Coached to quietly talk himself though tasks, step-by-step, as a means to maintain focus and sequence tasks appropriately.

Regular refresher breaks to help refresh and refocus (e.g., movement or water breaks), given before student becomes overwhelmed and starts to lose focus.

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Behavior Modification cont.

Consistent praise for periods of (for example) ten minutes or more, when child remains on-task.

Consider other rewards at school and home for substantial periods of controlled and attentive behavior (including assignments successfully completed).

Slide17

Organization

Clean workspace

Maintain planner and review notes with teachers to ensure that student has recorded each item and understands the purpose of each assignment.

Checklist for materials

Organized binder with sections devoted to each subject where hand-outs, notes, and assignments can be placed.

Structure!

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Oppositionality

Time-out (approximately 5 – 10 minutes) in a quiet, supervised

area (should not be able

to use behavior as

manipulation to

avoid

work)

Student should be given one calm, but firm warning when becoming disorderly.

If student does not heed warnings, there should be a consistent system in place for applying sanctions. The use of time-outs and/or taking privileges away for unruly behavior may be beneficial.

Oppositional students tend to respond best to both high structure and high warmth.

Consistent

disciplinary procedures be followed at both school and home.

Slide19

Positive Behavior Support

Proactive

rather tha

n reactive

approach

Set

basic

and

clear

expectations for behavior

Be safe

Be respectful of others

Be responsible for students own

well-being

Clear examples of what it means to meet these expectations in various contexts should be given

.

PBIS.org

Slide20

PBS cont.

Student should receive the most attention (and also praise) when meeting expectations.

Respond to any negative behaviors with

brief

redirection in a calm but firm manner, by stating and optimally demonstrating the type of behavior you want to see instead.

Slide21

PBS cont.

Error corrections

should be provided.

Set expectations and

pre-correct

as much as possible. Monitor his response to the pre-corrections and provide reinforcement accordingly

.

Reward

positive

behaviors rather than punish

negative

ones (5:1 ratio)

Praise and error corrections should follow a NORMS format (Neutral, Observation-based, Reliable, Measurable, and Supportive).

Slide22

PBS cont.

PBS approach should be extended into the home

If significant externalizing behaviors persist despite consistent behavioral intervention, a therapeutic school setting may be of benefit.

Provide emotional and behavioral support

Individualized attention, smaller class sizes

Slide23

Thanks!

Contact info:

r.andaloro@metrowestneuropsych.com

Metrowest

Neuropsychology

1900

West Park Drive, Suite 280

Westborough, MA

01581

www.metrowestneuropsych.com