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ADHD regionale aanpak

ADHD regionale aanpak. J.kooijman 14 en 17 december 2009 Huisartsen onderwijs. DSM IV Criteria. Oppositionele gedragsstoornis 40%. Tics 11%. Motorische stoornis=DCD 50%. Co-morbiditeit bij kinderen. Dyslexie NLD(?) 50% dyscalculie. ADHD alleen 31%.

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ADHD regionale aanpak

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  1. ADHD regionale aanpak • J.kooijman 14 en 17 december 2009 • Huisartsen onderwijs

  2. DSM IV Criteria

  3. Oppositionele gedragsstoornis 40% Tics 11% Motorische stoornis=DCD 50% Co-morbiditeit bij kinderen Dyslexie NLD(?) 50% dyscalculie ADHD alleen 31% Autisme Spectrumstoornissen 20%-50%? PDD-NOS Angst stoornis 34% Depressie 4% Dwang drang

  4. Etiologies of ADHDFrom Joel Nigg (2006), What Causes ADHD? Other Perinatal Smoking Lead FASD LBW Heritable (Genetics)

  5. Educational Outcomes • More grade retention (20-45%; MKE: 42 vs. 13) • Pagani et al. (2001) & Hauser (2007) show retention is harmful • More placed in special educational (25-50%) • More are suspended (40-60%; MKE: 60 vs. 19) • Reflects disciplinary action; more associated with CD • Greater expulsion rate (10-18%; MKE: 14 vs. 6) • Higher drop out rate (23-40%; MKE 32 vs 0) • Lower academic achievement test scores • Lower Class Ranking (MKE: 66% vs. 53%) • Fewer enter college (MKE: 22 vs. 77%) • Lower college graduation rate (5-10 vs. 35%) • MKE = Milwaukee Young Adult Outcome StudyMKE: 1.8 vs. 2.4)

  6. Educational Outcomes 100 90 80 70 60 50 H+ADHD Percent of Group 40 H-ADHD Community 30 20 10 0 HS Retained in College Diagnosed Diagnosed Spec. Ed. Graduate Grade Graduate LD BD Type of Outcome Educational Outcomes (age 27)(Milwaukee Study) H+ADHD = Hyperactive as a child and still ADHD at adult outcome (4+ symptoms and 1+ impairments); H-ADHD = Hyperactive as a child but is not diagnosable as ADHD at adult outcome; Controls = Community control group

  7. Lifetime Antisocial Acts 80 70 60 50 40 Percent of Group H+ADHD 30 H-ADHD 20 Community 10 0 Stolen Breaking Assault - Assault - Carried Sold Disorderly Arrested Jailed Property + Fists Weapons Weapons Drugs Entering Type of Act Antisocial Activities (age 27) H+ADHD = Hyperactive as a child and still ADHD at adult outcome (4+ symptoms and 1+ impairments); H-ADHD = Hyperactive as a child but is not diagnosable as ADHD at adult outcome; Controls = Community control group

  8. 100 Syndromatische remissie Symptomatische remissie 80 Functionele remissie 60 Patients in remission (%) 40 20 0 <6 6-8 9-11 12-14 15-17 18-20 • Biederman et al 2000

  9. Adhd diagnostiek • Anamnese -- luisteren • Vragenlijsten • Uitsluiten andere pathologie • Vaststellen comorbiditeit

  10. Behandeling • Medikamenteus • Psycho edukatie

  11. Adhd prevalentie • 3-4 % van de bevolking • een per schoolklas 25-30 leerlingen

  12. Regionale aanpak • Verregaande versnippering • Hulpverleners : • GGD , jeugdzorg , GGZ , Amphia ,Hans Berger , PEC , etc ….. • Psychologen , kinderartsen , neurologen , psychiaters , • vele anderen (speltherapie , hippotherapie , voedingstherapie , neurofeedback, kleitherapie ) • Wachtlijsten ………

  13. ADHD regionale aanpak • 2001 poging tot gestruktureerde aanpak mislukt op financiele gronden • Initiatief vanuit GGD

  14. ADHD regionale aanpak • Toenemende samenwerking Kinderartsen - GGZ • In den lande voorbeelden bv Delft

  15. Samenwerking GGZ - Kinderartsen • GGZ begeleiding van patienten • Psycho-edukatie – oudertraining 1 • Oudertraining 2 • Kindertraining • Sociale vaardigheid • Thuisondersteuning • Kinderpsychiatrische begeleiding • Kinderartsen - • medikamenteuze behandeling • Medische ondersteuning

  16. Samenwerking GGZ - kinderartsen • 1. verwijzingen laagdrempelig • 2. gezamenlijk diagnostische voordeur • Adhd centrum Breda

  17. Samenwerking GGZ – kinderartsen • Visie : • Duidelijke verwijsstruktuur • Aanpak : Simpel waar mogelijk , uitgebreid waar nodig

  18. Verwijzen Kind met ADHD verdenking Rol van de kinderarts “enkelvoudige ADHD “ Rol van GGZ Probleem op meer terreinen Rol School Leerproblemen identficeren en diagnosticeren

  19. Toekomst • ADHD centrum Breda • Duidelijke verwijsstruktuur • Eenduidige diagnostische benadering • Getrapte behandeling • Wachtlijst terugdringen

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