ADHD is diagnosed through clinical history, examination, and sometimes investigations. It is characterized by inattention, hyperactivity, and impulsivity. Treatment includes non-pharmacological options like behavior management as well as pharmacological options like stimulant medications which are the first-line treatment.
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Diagnosis And Treatment Of Attention Defect Hyperactivity Disorder (ADHD)
1. TUTOR CASE 3: ATTENTION
DEFICIT HYPERACTIVITY
DISORDER (ADHD)
Presented by:
Arwa H. Al-
Onayzan.
ID: 215007943.
2. LEARNING OBJECTIVES
Q5: How is ADHD diagnosed?
Q6: Which treatment options are available for ADHD?
(pharmacological and non-pharmacological).
3. INTRODUCTION
Attention deficit hyperactivity disorder (ADHD):
Is a disorder that manifests in childhood with symptoms of
hyperactivity, impulsivity, and/or inattention.
The symptoms affect:
Cognitive.
Academic.
Behavioral.
Emotional.
Social functioning
4. HOW IS ADHD DIAGNOSED?
1- History.
2- Clinical
examination
3-
Investigation.
5. 1- HISTORY
• ADHD is a diagnosis made by clinical history.
Source of history History from parents, teachers and other carers.
Focus of history Core symptoms of ADHD.
Family history History of ADHD, substance use, and other psychiatric
illnesses.
Developmental history Information about pregnancy, and birth
history.
Past medical history Any CNS trauma or infections.
Psychosocial history Tensions in the home.
Past psychiatric history Learning disabilities, mood disorders.
6. 2- CLINICAL EXAMINATION
1- Mental status examination:
It’s a part of the diagnostic
evaluation.
Appearance, orientation,
cognitive.
Signs of ADHD including:
Motor restlessness.
Hyperactivity.
Inattention.
2- Neuropsychological tests:
It’s not necessary for the
diagnosis.
Considered in cases in which it
is important to differentiate
ADHD from:
Learning disabilities.
Disorders of language.
Visual-motor, or auditory
processing.
7. 3- INVESTIGATION
• If medical history of ADHD is unremarkable laboratory testing is
necessary.
• Some medical conditions can mimic the symptoms of ADHD:
Traumatic brain injury.
Encephalopathy.
Lead exposure, or thyroid disorder.
If these are suspected, specific tests should be
ordered patients referred to the appropriate
specialists.
11. TREATMENT OPTIONS FOR ADHD
1) Non-pharmacological treatment:
Psychoeducation.
Anticipatory guidance includes:
• Providing proactive strategies to solve adverse effects on learning, school
functioning, social relationships, family life, and self-esteem.
Behavioral management.
Social skills training or additional mental health treatments.
• May assist some children with behavior change or preservation of self-
esteem.
12. CON…
2) Pharmacological treatment:
I. Stimulant medications (methylphenidate or amphetamine compounds)
are the first-line agents for treatment of ADHD.
Available in short-acting, intermediate-acting, and long-acting forms.
Preparations include liquid, tablets, capsules, and a transdermal patch.
II. Nonstimulant medications, including atomoxetine (norepinephrine-
reuptake inhibitor), guanfacine, or clonidine (alpha agonists).
Helpful in situations such as:
Nonresponse to stimulant medication or family preference.
14. QUIZ TIME!
Q1- The first line of treatment to treat ADHD is:
A- Stimulant medications.
B- Nonstimulant medications.
Q2- Does Thomas fulfill the DSM-5 (ADHD) criteria?
A- Yes.
B- No.
16. REFERENCE
• American Psychiatric Association. Diagnostic and statistical manual of
mental disorders, 5th ed., (DSM-5). Washington, DC: American Psychiatric
Publishing; 2013.
• Pliszka S, AACAP Work Group on Quality Issues. Practice parameter for the
assessment and treatment of children and adolescents with attention-
deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry.
2007;46:894-921.
• Pineda DA, Puerta IC, Aguirre DC, et al. The role of neuropsychological
tests in the diagnosis of attention deficit hyperactivity disorder. Pediatr
Neurol. 2007;36:373-381.
• Attention-deficit and disruptive behavior disorders. In: Diagnostic and
Statistical Manual of Mental Disorders Fourth Edition Text Revision, 4th,
American Psychiatric Association, Washington, DC 2000. p.85.
• Marcdante, K. (2015). Nelson Essentials of Pediatrics. 7th ed. pp.41-42.
Notes de l'éditeur
The prevalence range was 19.6% in UAE.
And in Saudi Arabia is 3.5% in 2010.
The classic triad of symptoms that characterize this syndrome are inattention, hyperactivity and impulsivity. Regardless of the classification system, children with ADHD are easily identified in clinics, schools and at home.
ADHD is a diagnosis made by clinical history that assesses behavior in different areas of the child's life.
Developmental history Information about pregnancy (maternal smoking, alcohol, and stress), birth history (including birth weight), and developmental milestones.
Source of history: his mother and his teatcher.
Focus history: he is hyperactive, he plays over the time, he get up from bed to play in the sleeping time, he can’t focused in doing one task, he intrupt all the classmate in the class time.
Developmental history: he born in 38 weeks of uncomplicated pregnancy. His mother not smoking or drinking alchol during the pregnancy. Normal birth weight.
Past medical history: he is not admitted to hospital before.
Family history: non of his sibiling has this condtion, however, his father is a little hyperactive and impatient.
It includes appearance, alertness and orientation, ability to relate with the interviewer, speech, mood and affect, thought process, and estimation of cognitive ability.
Because ADHD is considered a behavioural disorder, neuropsychological testing is not necessary for the diagnosis.
In neuropsychological testing, patients with ADHD will generally have normal cognitive ability and academic achievement but will exhibit deficits in executive functions (those required to plan, prioritise, attend to, and inhibit behaviours).
Neuropsychology looks at how the health of the brain affects your thinking skills and behavior.
ABDEGH
Psychoeducation: Educating affected children and their parents about the diagnosis, treatment options, and prognosis.
Behavioural therapy consists of parent training in communication, positive feedback, effective time-outs, and coordination of a school behavioural plan.
This approach to ADHD treatment involves rewarding and praising your child’s good behavior and discouraging unwanted or impulsive behavior with appropriate consequences.
Stimulant medications (methylphenidate or amphetamine compounds) are the first-line agents for treatment of ADHD due to extensive evidence of effectiveness and safety.
Non stimulant helpful in situations such as:
Nonresponse to stimulant medication.
family preference, concerns about medication abuse or diversion, and coexisting tic or
sleep problems.
The modes of action of pharmacological treatments for ADHD are not fully understood; however, agents such as methylphenidate, amfetamine, atomoxetine and guanfacine all appear to have distinct effects on dopamine and noradrenaline signalling pathways in the brain.
Stimulants are the most prescribed medications for ADHD. They’ve been used to treat attention issues since the 1960s. They target a certain type of brain chemical called dopamine. Dopamine plays a role in motivation and executive function. It also helps kids control their movements and emotions.
Non-stimulants are a newer option. They target a different neurotransmitter called norepinephrine, which also plays a role in executive function. It helps kids control their emotions and be able to start and complete tasks, for instance.
Non-stimulants can be very effective for some kids with ADHD. But for most, they don’t have the same rate of success as stimulants, which work well in about 70 to 80 percent of cases.
Common side effects include appetite suppression and
sleep disturbance with stimulant medications.
gastrointestinal tract symptoms with atomoxetine, and sedation with alpha
agonists. These side effects usually can be managed by careful
adjustment of medication dosage and timing.
