DOES THIS ACTIVE CHILD HAVE ATTENTION DEFICIT
Description: DOES THIS ACTIVE CHILD HAVE ATTENTION DEFICIT HYPERACTIVITY DISORDER? SIGNIFICANCE OF ADHD Prevalence 5.29 (worldwide), 4.9 (local) 5 out of 100 children have ADHD 2 out of a class of 40 may have ADHD 4th highest contributor to disease
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slide1. DOES THIS ACTIVE CHILD HAVE ATTENTION DEFICIT HYPERACTIVITY DISORDER?<br>
slide2. SIGNIFICANCE OF ADHD Prevalence 5.29% (worldwide), 4.9% (local)
5 out of 100 children have ADHD
2 out of a class of 40 may have ADHD
4th highest contributor to disease burden locally with 6% DALY (Disability-Adjusted Life Year) for children aged 14 and below1
Estimated average cost of ADHD per year per child was €5733 (~SGD$10K)2<br>
slide3. IN THIS VIDEO, YOU WILL LEARN To differentiate a normal active child from ADHD child
To diagnose ADHD according to DSM-53 criteria
To manage ADHD at primary care clinic
When to refer<br>
slide4. DIAGNOSIS OF ADHD: INATTENTION SYMPTOMS<br>
slide5. DIAGNOSIS OF ADHD: HYPERACTIVITY-IMPULSIVITY SYMPTOMS<br>
slide6. DIAGNOSIS OF ADHD IS CLINICAL (DSM-5 CRITERIA)3 Ryan is unlikely to have ADHD<br>
slide7. DIAGNOSIS OF ADHD: INATTENTION SYMPTOMS<br>
slide8. DIAGNOSIS OF ADHD: HYPERACTIVITY-IMPULSIVITY SYMPTOMS<br>
slide9. DIAGNOSIS OF ADHD IS CLINICAL (DSM-5 CRITERIA)3 John has ADHD, predominantly combined hyperactive-impulsive presentation<br>
slide10. DIFFERENTIAL DIAGNOSIS FOR ADHD CHILD<br>
slide11. CO-MORBIDITIES FOR ADHD CHILD Specific Learning Disorder (LD)
Oppositional Defiant Disorder (ODD) or Conduct Disorder (CD)
Autism Spectrum Disorder (ASD)
Intellectual Disability (ID)
Emotional Disorders (Anger, Anxiety/Depression)
Others: Tics & Tourette Syndrome, Substance-related Disorder<br>
slide12. MANAGEMENT AT A GLANCE Behavioural Intervention
Behaviour management strategies
(e.g. clear rules, use of rewards/privilege withdrawal)
Classroom behaviour management
Academic intervention
Parental training
(at Family Service Centre esp. for pre-schoolers, or parent support group SPARK6)<br>
slide13. 2. (a) Medications (depend on age, severity of symptoms, co-morbidities, efficacy, side effects profile)<br>
slide14. MANAGEMENT AT A GLANCE (b) Other medications:
Bupropion (NDRI: Norepinephrine-Dopamine Reuptake Inhibitor)
Guanfacine, Clonidine (both are alpha2 agonists)
Tricyclic antidepressants (rarely used)
Others (insufficient evidence)
Reduce food colouring/sugars/hyper-allergenic food/benzoate preservatives
Supplement with omega-3/fish oil/vitamin/mineral/zinc & iron
Neurofeedback, cognitive remediation, acupuncture, relaxation, hypnotherapy<br>
slide15. Practical Approach to an Active Child in Primary Care Clinic Legend:
KKH DCD – Kandang Kerbau Women’s and Children’s Hospital, Department of Child Development
NUH CDU – National University Hospital, Child Development Unit
IMH CGC – Institute of Mental Health, Child Guidance Clinic
HPB CGC – Health Promotion Board, Child Guidance Clinic<br>
slide16. When to Refer Diagnosis of ADHD unsure, assessment required
Co-morbidities present, assessment required
(e.g. ASD, LD, IQ testing)
Contraindication in treatment
(e.g. family history or past history of cardiac conditions, require cardiologist review)
Other modalities of treatment required
(e.g. behavioural therapy with psychologist, anger management with school counsellor)
Failed pharmacotherapy or complications from pharmacotherapy<br>
slide17. REFERENCES AMS-MOH Clinical Practice Guidelines: Attention Deficit Hyperactivity Disorder. (2014). 1st ed. Singapore: Published by MOH. https://ams.edu.sg/view-pdf.aspx?file=media%5C2014_fi_176.pdf&ofile=ADHD+CPG_Booklet.pdf
Quintero J, Ramos-Quiroga J, Sebastián J. Health care and societal costs of the management of children and adolescents with attention-deficit/hyperactivity disorder in Spain: a descriptive analysis. BMC Psychiatry [Internet]. 2018 [cited 20 September 2019];18(40). https://bmcpsychiatry.biomedcentral.com/track/pdf/10.1186/s12888-017-1581-y
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425596
About REACH (Response, Early intervention and Assessment in Community mental Health) – Institute of Mental Health. https://www.imh.com.sg/clinical/page.aspx?id=1635
SPARK. The Society for the Promotion of Attention-Deficit Hyperactivity Disorder Research & Knowledge. https://www.spark.org.sg
Family Service Centre. http://www.parenting.sg/family_service_centres.htm
NICHQ Vanderbilt Assessment & Follow-up Scale for Parent Informant & Teacher Informant. https://www.nichq.org/sites/default/files/resource-file/NICHQ_Vanderbilt_Assessment_Scales.pdf
McCabe, J. (2018). Failing at Normal: An ADHD Success Story | Jessica McCabe | TEDxBratislava. https://www.youtube.com/watch?v=JiwZQNYlGQI<br>
slide18. ACKNOWLEDGMENT<br>
slide19. DISCLAIMER The information in this video is correct to the best of our knowledge at the point of circulation. It is by no means exhaustive. Please refer to the above references & other materials to consolidate your appreciation of the subject. The authors disclaim any liability in connection with the use of this information.
All rights reserved. No part of this video may be reproduced, distributed or transmitted in any form by any means without the permission of the authors.<br>
slide2. SIGNIFICANCE OF ADHD Prevalence 5.29% (worldwide), 4.9% (local)
5 out of 100 children have ADHD
2 out of a class of 40 may have ADHD
4th highest contributor to disease burden locally with 6% DALY (Disability-Adjusted Life Year) for children aged 14 and below1
Estimated average cost of ADHD per year per child was €5733 (~SGD$10K)2<br>
slide3. IN THIS VIDEO, YOU WILL LEARN To differentiate a normal active child from ADHD child
To diagnose ADHD according to DSM-53 criteria
To manage ADHD at primary care clinic
When to refer<br>
slide4. DIAGNOSIS OF ADHD: INATTENTION SYMPTOMS<br>
slide5. DIAGNOSIS OF ADHD: HYPERACTIVITY-IMPULSIVITY SYMPTOMS<br>
slide6. DIAGNOSIS OF ADHD IS CLINICAL (DSM-5 CRITERIA)3 Ryan is unlikely to have ADHD<br>
slide7. DIAGNOSIS OF ADHD: INATTENTION SYMPTOMS<br>
slide8. DIAGNOSIS OF ADHD: HYPERACTIVITY-IMPULSIVITY SYMPTOMS<br>
slide9. DIAGNOSIS OF ADHD IS CLINICAL (DSM-5 CRITERIA)3 John has ADHD, predominantly combined hyperactive-impulsive presentation<br>
slide10. DIFFERENTIAL DIAGNOSIS FOR ADHD CHILD<br>
slide11. CO-MORBIDITIES FOR ADHD CHILD Specific Learning Disorder (LD)
Oppositional Defiant Disorder (ODD) or Conduct Disorder (CD)
Autism Spectrum Disorder (ASD)
Intellectual Disability (ID)
Emotional Disorders (Anger, Anxiety/Depression)
Others: Tics & Tourette Syndrome, Substance-related Disorder<br>
slide12. MANAGEMENT AT A GLANCE Behavioural Intervention
Behaviour management strategies
(e.g. clear rules, use of rewards/privilege withdrawal)
Classroom behaviour management
Academic intervention
Parental training
(at Family Service Centre esp. for pre-schoolers, or parent support group SPARK6)<br>
slide13. 2. (a) Medications (depend on age, severity of symptoms, co-morbidities, efficacy, side effects profile)<br>
slide14. MANAGEMENT AT A GLANCE (b) Other medications:
Bupropion (NDRI: Norepinephrine-Dopamine Reuptake Inhibitor)
Guanfacine, Clonidine (both are alpha2 agonists)
Tricyclic antidepressants (rarely used)
Others (insufficient evidence)
Reduce food colouring/sugars/hyper-allergenic food/benzoate preservatives
Supplement with omega-3/fish oil/vitamin/mineral/zinc & iron
Neurofeedback, cognitive remediation, acupuncture, relaxation, hypnotherapy<br>
slide15. Practical Approach to an Active Child in Primary Care Clinic Legend:
KKH DCD – Kandang Kerbau Women’s and Children’s Hospital, Department of Child Development
NUH CDU – National University Hospital, Child Development Unit
IMH CGC – Institute of Mental Health, Child Guidance Clinic
HPB CGC – Health Promotion Board, Child Guidance Clinic<br>
slide16. When to Refer Diagnosis of ADHD unsure, assessment required
Co-morbidities present, assessment required
(e.g. ASD, LD, IQ testing)
Contraindication in treatment
(e.g. family history or past history of cardiac conditions, require cardiologist review)
Other modalities of treatment required
(e.g. behavioural therapy with psychologist, anger management with school counsellor)
Failed pharmacotherapy or complications from pharmacotherapy<br>
slide17. REFERENCES AMS-MOH Clinical Practice Guidelines: Attention Deficit Hyperactivity Disorder. (2014). 1st ed. Singapore: Published by MOH. https://ams.edu.sg/view-pdf.aspx?file=media%5C2014_fi_176.pdf&ofile=ADHD+CPG_Booklet.pdf
Quintero J, Ramos-Quiroga J, Sebastián J. Health care and societal costs of the management of children and adolescents with attention-deficit/hyperactivity disorder in Spain: a descriptive analysis. BMC Psychiatry [Internet]. 2018 [cited 20 September 2019];18(40). https://bmcpsychiatry.biomedcentral.com/track/pdf/10.1186/s12888-017-1581-y
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425596
About REACH (Response, Early intervention and Assessment in Community mental Health) – Institute of Mental Health. https://www.imh.com.sg/clinical/page.aspx?id=1635
SPARK. The Society for the Promotion of Attention-Deficit Hyperactivity Disorder Research & Knowledge. https://www.spark.org.sg
Family Service Centre. http://www.parenting.sg/family_service_centres.htm
NICHQ Vanderbilt Assessment & Follow-up Scale for Parent Informant & Teacher Informant. https://www.nichq.org/sites/default/files/resource-file/NICHQ_Vanderbilt_Assessment_Scales.pdf
McCabe, J. (2018). Failing at Normal: An ADHD Success Story | Jessica McCabe | TEDxBratislava. https://www.youtube.com/watch?v=JiwZQNYlGQI<br>
slide18. ACKNOWLEDGMENT<br>
slide19. DISCLAIMER The information in this video is correct to the best of our knowledge at the point of circulation. It is by no means exhaustive. Please refer to the above references & other materials to consolidate your appreciation of the subject. The authors disclaim any liability in connection with the use of this information.
All rights reserved. No part of this video may be reproduced, distributed or transmitted in any form by any means without the permission of the authors.<br>