1 / 39

Attention Deficit/Hyperactivity Disorder

This comprehensive overview of Attention Deficit/Hyperactivity Disorder (ADHD) delves into its symptoms, diagnosis criteria, and treatment options. Dr. Jillian Schneider, a pediatric neuropsychologist, provides insights into how ADHD manifests differently in boys and girls, its prevalence, and the potential for coexisting conditions. The discussion also covers common misconceptions, the impact of ADHD across the lifespan, and effective strategies for management. Whether you’re a parent seeking information or a professional in the field, this resource offers valuable knowledge about ADHD.

aimee-william
Download Presentation

Attention Deficit/Hyperactivity Disorder

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Attention Deficit/Hyperactivity Disorder Jillian C. Schneider, Ph.D. Pediatric Neuropsychologist Fairfax Neonatal Associates February 11 2014

  2. Background and Training • Doctoral Degree: Ph.D. in Clinical Psychology from Drexel University • Pre-doctoral training: Kennedy Krieger Institute/The Johns Hopkins University School of Medicine • Post-doctoral training (two year fellowship): Children’s National Medical Center • Previous employment: independent pediatric neuropsychology practice, contractor with Department of Defense • Publications include book chapters and articles on infectious disease and mild traumatic brain injury in peer reviewed journals

  3. Commonly Asked Questions • What is attention? • What is ADHD? • How is ADHD diagnosed? • How is ADHD treated?

  4. What is Attention? • Process whereby individuals receive and process incoming information • Subtypes: • Span • Focused • Selective • Sustained (vigilance/concentration) • Alternating • Divided

  5. What is Executive Functioning • Enables individuals to engage in independent, purposeful behavior • Domains: • Inhibitory control, Behavioral/emotional regulation • Mental flexibility • Initiation • Working memory • Planning, Organization, Goal setting • Abstract reasoning, Problem-solving, Hypothesis generation • Self-monitoring

  6. What is ADHD? • What are the symptoms? • What’s the difference between ADHD and ADD? • Can a gifted child be diagnosed with it? • Is it different in girls vs. boys? • Do children grow out of it? • How common is it? • What causes it?

  7. Inattention Hyperactivity Impulsivity What is ADHD?

  8. Inattention • Inattention to detail, makes careless mistakes • Trouble staying focused and on task • Not listening • Not following through with instructions or tasks • Disorganized • Avoids and dislikes tasks that require sustained effort • Loses things • Easily distracted • Forgetful

  9. Hyperactivity • Fidgets or squirms in seat • Trouble sitting still • Runs or climbs at inappropriate times • Trouble playing quietly • Often “on the go,” acts as if “driven by a motor” • Talks excessively

  10. Impulsivity • Blurts out answers • Difficulty waiting his/her turn • Interrupts or intrudes on others

  11. ADHD Subtypes • Predominantly Inattentive Presentation • 6 (5 in adults) or more symptoms of inattention • Predominantly Hyperactive/Impulsive Presentation • 6 (5 in adults) or more symptoms of hyperactivity or impulsivity • Combined Presentation • at least 6 (5 in adults) symptoms of inattention AND 6 (5 in adults) symptoms of hyperactivity or impulsivity

  12. ADHD Diagnostic Criteria • Several symptoms of inattention and/or hyperactivity and impulsivity are present before age 12 years • Symptoms are present in two or more settings • Symptoms interfere with or reduce the quality of social, academic, or occupational functioning • Symptoms are not better accounted for by another disorder

  13. How Common is ADHD?

  14. ADHD: Boys vs. Girls

  15. ADHD: Boys vs. Girls • Compared to boys, girls: • Rated lower on scales in hyperactivity and impulsivity • Display fewer behavioral problems • Have more internalizing problems (e.g., depression, anxiety) • Clinical presentation in girls: • Inattention –spacey, daydreamers, may appear shy • Hyperactivity –extremely talkative

  16. Can ADHD be Diagnosed in Gifted Children? • Yes, ADHD and GT can co-exist. • Like most children with ADHD, gifted children with ADHD: • may display problems with sustained attention and hyperactivity in less stimulating or motivating environments • may display academic inconsistencies and/or underachievement • May exhibit a wider gap between intellectual functioning and social/emotional functioning

  17. Do Children Grow out of ADHD? • No, most children do not “grow out” of ADHD • In general, ADHD increases the risk for academic and occupational underachievement, substance abuse, delinquent behavior, relationship problems, trouble managing stress, etc. • However, many children learn various coping strategies for managing their difficulties.

  18. ADHD Across the Lifespan • Preschool • Poor sustained attention, easily distracted • Elevated gross motor activity • School Age • Poor sustained attention, distractibility • Inconsistent academic progress • Restless, fidgety • Adolescence/Adulthood • Problems with sustained effort and concentration • Executive functioning weaknesses • Internal feelings of restlessness • Participation in risky activities • Academic / occupational underachievement

  19. Comorbidity: Rule Not the Exception Tourette/Tics 10% Learning Disability 46% ADHD Conduct Disorder 27% Speech Problems 12% Autism Spectrum Disorder 25% Anxiety 18% Depression 14%

  20. What Causes ADHD: Neurodevelopment • Differences in brain maturation, structure, and function • Prefrontal cortex • Basal ganglia • Cerebellum

  21. What Causes ADHD: Genes and the Environment • Familial and significantly heritable • 30-35% of first-degree relatives of children with ADHD also have the disorder • Environmental Risk Factors • Premature birth and birth complications • Maternal smoking and substance use • Lead exposure/toxicity • Traumatic brain injury

  22. What Doesn’t Cause ADHD? • Bad parenting • Sugar • Diet • Too much television • Videogames

  23. How is ADHD Diagnosed? • What kind of psychological work-up should be done to make a diagnosis? • Is there a specific test used to diagnose ADHD? • Where should I go to get a diagnostic evaluation?

  24. Diagnosing ADHD • Diagnostic requirements: • At least 6 symptoms of inattention and/or 6 symptoms of hyperactivity/impulsivity • Symptoms must: • have been present before age 12 • have persisted for at least six months • be present across two different settings • be present to a degree that causes problems and is inconsistent with developmental level • Symptoms are not better accounted for by another disorder

  25. Assessing Symptoms of ADHD • There is NO test for ADHD • Diagnosis is made based on information gathered about presenting concerns/symptoms through: • Review of development and clinical history • Historical review of concerning behaviors • Behavioral observation

  26. Standardized Assessment of ADHD • Standardized assessment may include: • Questionnaires/rating scales completed by parents and teachers • Cognitive testing • Assessment should be individualized to an individual child’s specific problems. • Considerations: • Children may do well on standardized tests • Performance may be variable on measures

  27. Symptoms of ADHD are not better accounted for by another disorder Medical • Hearing/vision problems • Intellectual disability • Learning disability • Language disorder • Sleep apnea • Seizure disorder • Metabolic disorder • Substance abuse Psychological • Depression or Anxiety • Behavioral problems • Stress or changes and sudden changes in life Environmental • Family dynamics • Academic environment

  28. Specialists who diagnose ADHD • Pediatrician/Developmental Pediatrician • Psychiatrist • Behavioral Neurologist • Psychologist/Neuropsychologist • The person conducting the evaluation should be a professional trained in assessing children’s development, emotions, and behavior and in differential diagnosis

  29. Neuropsychological Evaluation • Assess learning and behavior in relation to an individual’s brain processes. • Intellectual functioning • Academic achievement • Language • Visual processing • Attention and concentration • Executive functioning • Learning and memory • Sensory and motor functioning • Affective, behavioral, and social functioning

  30. Neuropsychological assessment is helpful when… • There is suspicion of low cognitive abilities • There is low academic achievement • In order to differentiate among coexisting disorders • In order to describe an individual’s strengths and weaknesses and to tailor recommendations and help with treatment and educational planning • In order to increase validity of diagnostic impressions • There are coexisting medical conditions (e.g., epilepsy)

  31. How is ADHD Treated? • There is no cure • The focus of treatment should be on reducing the symptoms of ADHD and improving functioning • Common treatment methods include: • Medication • Behavioral/Cognitive Behavioral Therapy • Combination of Treatment • Medication > Medication + Behavioral Intervention > No Treatment

  32. Medication • Medications Types: • Psychostimulants (e.g., Ritalin, Adderall, Concerta) • Non-stimulants (e.g., Strattera, Tenex, Intuniv) • Short vs. Long Acting • Pill/capsule, Liquid, Skin patch • Side Effects: • Decreased appetite, sleep problems, anxiety, irritability • Not a one-size-fits-all approach –finding the right medication requires careful and continuous fine-tuning

  33. Behavior / Cognitive Behavior Therapy • Behavioral Parent /Teacher Training • Focuses on teaching the child more socially acceptable behavior by training caregivers and teachers in contingency management strategies. • Academic Interventions • Environmental modifications, curriculum changes, testing accommodations, assistive technology • Peer-related Interventions • Addresses difficulties that children have with initiating and maintaining appropriate peer relationships

  34. Alternative and Complementary Treatments • Treatments that have not been scientifically validated to improve symptoms of ADHD • Dietary changes • Herbal supplements • Chiropractic adjustments • Interactive metronome training • Eye or vision training and special colored glasses • EEG biofeedback

  35. Resources • Books for Parents • Taking Charge of ADHD: The Complete Authoritative Guide for Parents by Russell Barkley • Parenting Children with ADHD: 10 Lessons that Medicine Can Not Teach by Vincent Monastra • How to Reach and Teach ADD/ADHD Children by Sandra Reif • Living with ADHD: A Practical Guide to Coping with ADHD by Rebecca Kajander • Executive Skills in Children and Adolescents: A Practical Guide to Assessment and Intervention by Peg Dawson and Richard Guare • Smart but Scattered: A Revolutionary “Executive Skills” Approach to Helping Kids Reach Their Potential by Peg Dawson and Richard Guare

  36. Resources Cont. • Books for Kids • Clayton’s Path by Brett Bishop • Joey Pigza Swallowed the Key by Jack Gantos • Help Is on the Way: A Child’s Book about ADD by Marc Nemiroff, Margaret Scott, and Jane Annunziata • Organizations • CHADD (Children and Adults with Attention Deficit Hyperactivity Disorder) www.chadd.org

  37. Questions

  38. Jillian C. Schneider, Ph.D. Fairfax Neonatal Associates 2720-D Prosperity Avenue Fairfax, Virginia 22031 (703) 752-2765

More Related