1. Dasar Dx ADHD ?

Answer: Attention-deficit/hyperactivity disorder (ADHD) is the most occur neurobehavioral

disorder in children, it is also chronically condition that most influence in school children, and it is a
disorder of way of thinking that always find in children , I diagnosed this patient with Attention
Deficit/Hyperactive Disorder (ADHD) because: the first based on Identity, the patient was 4.5 years old
where epidemiologically, ADHD was most often detected when the child was in kindergarten age. Then
from the history of present illness, it was found that there were complaints from the mother of delays in
fine motor abilities, where ADHD children were also often accompanied by developmental delays,
especially in fine motor and language. From the anamnesis was also found that she always distract with
another things, patient cannot stay focus on 1 toys, she is too active and can't focus on doing anything
and gets distracted a lot. Which is ADHD characterized by 3 main symptoms, there are inattention,
hyperactivity, and impulsivity. From examination, we use DSM V as tools to diagnosed the ADHD with
this criteria. And the result from this screening was patient have following symptoms that persited more
than 6 months. From this screening patients tend to be hyperactive type of ADHD.

2. Faktor risiko pada pasien ADHD secara keseluruhan dan pada pasien ini?

Answer: the etiology or risk factor of ADHD still being identified until now. But it most probable cause
that the role of genetic and environmental factors has an important influence on development. The are
some study reported the other factors that increase the risk of ADHD are poisoning, post infection, and
post trauma on antenatal and postnatal.

3. Patogenesis ADHD

Answer : The exact cause of ADHD is not known yet. From some study that reported data from
neuroimaging, neuropsychology, genetics and neurochemical studies has consistently point that there is
involvement of the frontostriatal network/pathway as a contributor to the pathophysiology of ADHD.
and the frontal cortex itself, are the main areas that theoretically responsible for the pathophysiology of
ADHD. Inhibitory mechanisms in the cortex, limbic system, and reticular activation system are also
affected. ADHD can affect one, two, three, or all of these areas, resulting in different types of ADHD.
Another pathofisiologi theory that in ADHD there is a reduction on total brain size, which is most effect
at spesific area in prefrontal cortex, nucleus caudatus, corpus callosum and cerebral vermis. In this
patient, the head circumference percentile for age was below 50 .

4. Goal dan planning dan prognosis

Answer : The prognosis for ADHD patients is generally good when:

1. No major comorbid factors
2. Patients and their caregivers receive adequate education about ADHD and its management
3. Obedient in carrying out the therapy
4. learning disabilities (developmental delay) that occur as diagnosed being reviewed and be treated.
5. All emotional problems are properly investigated and managed by a general practitioner or the
patient is referred to a professional mental health center professional
At least 80% of children with ADHD have persistent symptoms to teenagers and even adults.
 5. Kapan mesti diterapi medika mentosa?

Answer: Medicamentosa therapy can be the first line of treatment for ADHD. Drugs in ADHD therapy act
as CNS stimulants, including short and sustained-release preparations such as methylphenidate,
dextroamphetamine, and a combination of dextroamphetamine and amphetamine. In the second line,
antidepressant drugs can also be given if the results of psychostimulant drugs are not effective for ADHD
children.

6. Latihan SI?
Answer: Sensory integration therapy is popular with occupational therapists and has been applied to
various clinical populations. For ADHD ??

7. Kenapa memilih latihan hand fx sperti itu?

Answer: There are several typical pencil grasps for development for handwriting, in this patient the way
of holding the pencil still seems weak for the quadrupod grasp, more likely with the palmar supine
grasp. Thats why, it is necessary to provide occupational therapy with hand function exercises for
patient’s age with writing in order to improve the patient's fine motor skills