ADHD

By:
Vignesh. N
BOT(2nd year)
211701015.
SYNOPSIS :
• Definition
• Etiology
• Subtypes
• Clinical features
• Diagnosis
• DSM-5 criteria for adhd
• Differential diagnosis
• Assessment tools
• Treatment.
Definition :
• Attention deficit hyperactivity disorder (ADHD) is characterised by a
pattern of diminished SUSTAINED ATTENTION and higher levels of
IMPULSIVITY in a child or adolescent than expected for someone of
that age and developmental level.
• Currently, the diagnosis of ADHD is based on the consensus of
experts that 3 observable subtypes :
• INATTENTION
• HYPERACTIVE/IMPULSIVE, or
• COMBINED.
• - KAPLAN AND
SADDOCK.
ETIOLOGY

• Genetic factors
• Developmental factors
• Brain damage
• Neurochemical factors
• Neurophysiological factors
• Psychosocial factors.
GENETIC FACTORS :
• Greater concordance in monozygotic than in
dizygotic twins.

• Siblings of hyperactive children have about twice

the risk of having the disorder.

• One symptoms may have predominantly

HYPERACTIVITY symptoms and others may have
predominantly INATTENTION symptoms.
DEVELOPMENTAL FACTORS :
• The implication is that prenatal exposure to winter infections
during the first trimester may contribute to the emergence of ADHD
symptoms in some susceptible children.

BRAIN DAMAGE :
It has been speculated that some children affected by ADHD
had subtle damage to the CNS and brain development during their
fetal and perinatal periods.
NEUROCHEMICAL FACTORS :

• Many neurotransmitters have been associated with ADHD

symptoms.
• Peripheral non – adrenergic system may be of more importance.
• The stimulants used in the treatment of ADHD affects both
DOPAMINE and NOREPINEPHRINE, leading to neurotransmitter
hypotheses that include possible dysfunction.
• Stimulants increase CATECHOLAMINE CONCENTRATIONS.
• Overall, no clearcut evidence implicates a single neurotransmitter
in the development of ADHD.
PSYCHOSOCIAL FACTORS :

• Stressful psychic events, disruption of family equilibrium,

and other anxiety – inducing factors contribute to the
initiation or perpetuation of ADHD.

• Predisposing factors may include the child’s

temperament, genetic – familial factors, and the demands
of society to adhere to a routinized way of behaving and
performing.
SUBTYPES :

1. Attention deficit disorder with hyperactivity.

Poor attention span with diatractibility.
Hyperactivity.
Impulsive.
2. Attention deficit disorder without hyperactivity.
3. Residual type.
4. Hyperkinetic disorder with conduct disorder.
CLINICAL FEATURES :

• Onset in infancy, although it is rarely recognised until a

child is at least toddler age.
• Sensitive to stimuli.
• Easily upset by noise, light, temperature, and other
environmental changes.
• Fails to finish the things started.
• Shifts from uncompleted activity to another.
• Doesn’t seem to listen.
• Easily distracted by external stimuli.
• Often loses things.
• Fidgety.
• Difficulty in sitting at one place for long.
• Moving about here and there.
• Talks excessively.
• Interference in other people activities.
• Acts before thinking.
• Explosive and irritable.
• Children are placid and limp.
• Aggression and defiances.
• School difficulties.
DIAGNOSIS :

• The diagnosis can be made on the basis of :

•
Teacher’s school report.
Parent report.
Clinical examination.

The principle signs of inattention, IMPULSIVITY, and

hyperactivity.
DIFFERENTIAL DIAGNOSIS :
• Anxiety in a child to be evaluated. Anxiety can accompany ADHD as a
secondary feature.

• Mania and adhd share many core features such as excessive

verbalization, motonic hyperactivity, and high levels of distractibility.

• Children with bipolar disorder exhibit waning of symptoms than those

with ADHD.
• Conduct disorder and adhd coexist.
• Learning disorders of various kinds must also be distinguished from
adhd.
ASSESSMENT TOOLS FOR ADHD:

1. Vanderbiltz ADHD diagnostic teacher rating scale for

ages 6 to 12.
2. Child behaviour checklist (CBCL) for ages 6 to 18.
3. Conners-wells’ adolescent self-report scale, which is for
teenagers.
4. Swanson, Nolan, and Pelham-IV Questionnaire (SNAP-
IV) for ages 6 to 18.
5. Conners comprehensive behaviour rating scale (CBRS)
TREATMENT (PROBLEMS) :-

• SELF CARE:-The person is often forgerful in

daily activities.
• PRODUCTIVITY:-The person of teen fails to to
give close attention to details or make
careless.
• The person often has
difficulty playing quietly.
• LEISURE:-The person often has difficulty
engaging in leisure activities quietly.
• SENSORIMOTOR:-The person often fidgets with
hands or feet or squirms in seat.
• The person
often leaves seat in classroom or in other
situated in which remaining seated is
expected.
• The person often runs about
or climbs excessively in situation in which
it is inappropriate.
• The person is often “on the
go” Or often act as if “driven by
another”.
• The person often talks
excessively.
• The person may have poor
perceptual motor skills.
• The person may have poor fine
motor skills.
PSYCHOLOGICAL TREATMENT:-

• PsychoEducation:- Refers to educating the

child and family about ADHD intervention
in school designed to,
• Improve School behavior,
• Academic productivity and
• Achievement.
• Remedial Tutoring:- ADHD children will have
comorbid learning disability education designed
to assist student in order to achieve expected
competencies in once academic skills.
• Parent Training In Behaviour Therapy:-Teaches the
parent how to implement a contigency management
behavioural programme.
• Parents group small Training session
held weekly 8 -20 weeks. More effective in
yonger.
• Family Therapy:-ADHD is frequently
associated with family conflicts Barkely,
• Structured family therapy
• Communication therapy
• Problem solving therapy
• not much improvements in Adolescents.
Cognitive Behavioral Therapy:-Programs were
designed to teach children about problems
solving, dealing with anger and
frustration.
Persistence and social
skills.
Individual Psychotherapy:- unlikely therapy
for ADHD symptoms but child can be made to
understand what ADHD is.
• Multimodel Treatment:- Study showed combined
medical and behavioral treatment was best
followed by medication treatment alone.
• Frame of Reference:-
• Sensory
Integration frame of reference.
•
Behavioral frame of reference.
THANK YOU