Attention deficit / Hyperactivity disorder

Send This

Download

Comment

Favourite

more

Rating :

Rate It:

Embed :

ahimani8 on Jun 11, 2012 Says :

nice

asia on Jun 08, 2010 Says :

It is a good presentation and i like it very much

Post a comment

Post Comment on Twitter Post Comment on SlideWorld

Comments:

Subscribe to follow-up comments

1 Favorites

tola_al3asola_eg, favourited this 1 Years ago.

First Prev [1] Next Last

Notes

Hide Notes

Slide 1 :

Attention Deficit/ Hyperactivity Disorder Dennis L. Hufford, CDR, MC, USN Faculty Development Fellowship Madigan Army Medical Center

Slide 2 :

Objectives Define Diagnostic Criteria Discuss Workup and Differentiation Discuss Therapy

Slide 3 :

ADHD: What is It? Triad: Inattentiveness, Hyperactivity, Impulsiveness Maladaptive and Pervasive Academic and Behavioral Problems Onset Prior to Age 7 Probable Organic Cause Exact Etiology Unknown

Slide 4 :

Prevalence 3-5 % of School Age Children (1:25) 2 % of Adolescents (1:50) 0.8 % of 20 year-olds (1:125) 0.2 % of 30 year olds (1:500) 0.05 % of 40 year olds (1:2000)

Slide 5 :

DSM IV Criteria EITHER: 6 symptoms of Inattention OR Hyperactivity & Impulsivity AND Onset before age 7 Impairment in at least 2 Settings Impairment in social, academic or occupational Function No other pervasive disorder

Slide 6 :

Pitfalls in Diagnosis DSM criteria also describe NORMAL kids! No Physical or Lab Markers Significant Overlap w/ Diff. Dx. Public Awareness, Misinformation

Slide 7 :

Diff. Dx. and Comorbid Conditions Oppositional Defiant Disorder Tic Disorders Learning Disabilities Mental Retardation Family Dysfunction/Discord Other Medical and Mental Disorders

Slide 8 :

Keys to Accurate Diagnosis History, History, and more History!! Standardized Checklists/Questionaires Exclusion of Diff. Dx. by Physical Exam IQ testing, audiometry, eye screening Multidiscliplinary Approach

Slide 9 :

History Behavioral incl. classroom, home, church, meals interactions with peers Medical: year by year school performance, developmental ROS: Neuro, GI esp. encopresis, psychiatric

Slide 10 :

History Family ADHD, tics, psychiatric disorders Social Family Dysfunction Parenting Skills Never the root of ADHD!

Slide 11 :

Useful Questions Is the child more apt to: do things without thinking ahead, or plan to misbehave? Refuse to do things or try to do things, but fails to finish? Does the child display aggression toward people or animals, destructiveness or theft? (inconsistent with ADHD)

Slide 12 :

Checklists/ Questionnaires “Objective” Data (?) Achenbach Behavior Checklist ADD II (ACTeRs) Connors Rating Scale Child Behavior Rating Scale Others

Slide 13 :

Physical Exam Directed Hearing and Vision Screening Developmental Milestones PE cannot rule-IN Diagnosis, only rules- OUT other Diff Dx.

Slide 14 :

Multidisciplinary Approach Primary Provider Psychoeducational Consultant academic, aptitude, and psychometric testing IQ measurement (usually done through the school) Social Services Counseling Services Individual and Family

Slide 15 :

Treatment/ Management Education Patient Parent Teachers and Caregivers Physician

Slide 16 :

Education Resources Books: Barkley RA. Taking Charge of ADHD: The Complete Authoritative Guide For Parents. New York, Guilford Press, 1995. Bain, LJ. A Parent’s Guide to Attention Deficit Disorders. New York,: Delta Books, 1991.

Slide 17 :

Education Resources Support Organization: CHADD: “Children and Adults with Attention Deficit Disorder” local chapters materials for children, adults, parents, schools 499 70th Ave NW, Suite 109, Plantation FL 33317. Ph. (800) 233-4050 Website: www.chadd.org/

Slide 18 :

Education Resources Special Education child may qualify for special services under Federal Law. (Individuals with Disabilities Education Act and section 504 of Rehabilitation Act of 1973) Schools responsible for determining eligiblility (they may need info from YOU)

Slide 19 :

Medical Therapy Medications Stimulants: methylphenidate (Ritalin) dextroamphetamine (Dexadrine) pemoline (Cylert) Others TCA’s, beta-blockers, bupropion, venlafaxine

Slide 20 :

Medication Doses: Methylphenidate: 0.3-0.5 mg/kg per dose administered bid or tid start low, titrate 5mg increments max 60 mg qd Dextroamphetamine 1/2 the methylphenidate dose Both meds have SR formulations

Slide 21 :

Medication Doses Pemoline Start 37.5 mg/day (1 pill) Increase by 18.75 mg at weekly intervals to response (1/2 pill) Usual effective range: 56.25-75 mg/day Maximum 112.5 mg/day (3 pills) Check LFTs at 6 month intervals

Slide 22 :

Stimulants Expected benefit Improved CONCENTRATION evidence: better grades, etc. All other benefits are secondary

Slide 23 :

Stimulants Problems Misinformation, Unrealistic Expectations Controlled Substance Adverse Effects Sleep disturbance Appetite Suppression Tics Anemias (rare)

Slide 24 :

Supportive Therapy Counseling/ Psychotherapy Behavior Modification Structured Schedule and Environment Regular Followups (not necessarily in person!) Social Services on-base support programs, training

Slide 25 :

Adult ADHD Relatively Rare, however… LOTS of Media Attention Lately! Comorbidity with Major Depression 12% of Adult MDD patients who had ADHD as children manifest ADHD symptoms May benefit from ADHD therapy

Slide 26 :

Adult ADHD Therapy Education Support Medication Stimulants TCA’s incl desipramine

Slide 27 :

Summary ADHD diagnosis and therapy is complex and labor intensive There are NO short-cuts in gathering necessary history and data! Emphasis on Diagnostic Accuracy by HISTORY Realistic Expectations of Therapies Multidisciplinary Approach

Slide 28 :

References Barbaresi, WJ. Primary Care Approach to the Diagnosis and Management of Attention-Deficit Hyperactivity Disorder. Mayo Clinic Proc, 1996 May, 71:5, 463-71. The best overview I found on the subject. Schneider, Steven and Tan, Grace. Attention-Deficit Hyperactivity Disorder: In Pursuit of Diagnostic Accuracy. Postgraduate Medicine, 1997 Apr., 101:4, 231-40. Concentrates on diagnostic features. Hill, JC and Schoener, EP. Age-Dependent Decline of Attention Deficit Hyperactivity Disorder. Am J Psychiatry, 1996 Sep, 153:9, 1143-6. Good picture of natural course of the disorder.

Slide 29 :

References (cont.) Mannuzza, S et al. Adult Psychiatric Status of Hyperactive Boys Grown Up. Am J Psychiatry, 1998 Apr, 155:4, 493-8. Abstract’s worth reading for what ADHD kids turn into! Johnson, TM. Evaluating the Hyperactive Child in Your Office: Is It ADHD? AFP, 1997 July, 56:1, 155-60. A middle of the road, “Here’s how I do it”. DSM IV, pp. 78-85. Criteria attached to handout. Descriptive.

Sleep disorders Insomnia

Treatment of Bipolar...

Attention deficit Hy...

Special situations i...

Prevalence of anxiet...

Psychiatric Disorder...

Free Powerpoint Templates

	flintoff 5 Years ago.



7933 Views, 2 favourite
PowerPoint Slide Presentation on
More By User Flag as inappropriate Select your reason for flagging this presentation as inappropriate. If needed, use the feedback form to let us know more details. Cancel