MODULE 7: ATTENTION-DEFICIT-HYPERACTIVITY-DISORDER

ADHD

Characterized by patterns of one or more of the following symptoms :inattention, hyperactivity, and impulsivity

INATTENTION

Such as having difficulty paying attention, keepin on task, or staying organized

HYPERACTIVITY

Such as often moving around (including during inappropriate times), feeling restless, or talking excessively

IMPULSIVITY

Such as interrupting, intruding on others, or having trouble waiting one’s turn

RISK FACTORS

GENETICS

PREGNANCY AND BIRTH FACTORS

BRAIN ANATOMY AND FUNCTION

PREGNANCY AND BIRTH FACTORS

→ lead exposure

→ alcohol or nicotine consumption 

→ prematurity

→ low birth weight

→ damage or infection to the CNS

USA

8.4% of children; 2.5% of adults; males > women

children

8.4%

adults

2.5%

PHILIPPINES

3-5% of the school-age population

the school-age population

3-5%

SIGNS AND SYMPTOMS: INATTENTIVENESS

→ short attention span

→ careless mistakes

→ forgetful

→ (-) stick to tasks

→ (-) listen or (-) carry out instructions 

→ constantly changing activity or task 

→ (-) organizing tasks

SIGNS AND SYMPTOMS: HYPERACTIVITY & IMPULSIVENESS

→ (-) sit still

→ fidgeting 

→ unable to concentrate on tasks 

→ excessive physical movement 

→ excessive talking

→ (-) wait for turn

→ acting without thinking

→ interrupting conversations 

→ no sense of danger

PREDOMINANTLY INATTENTIVE

→ ADHD I

→ (-) organizing or finishing task, (-) paying attention to details or to follow instructions or conversation, distracted, forgetful

PREDOMINANTLY HYPERACTIVE-IMPULSIVE

→ ADHD H

→ fidgets, talks alot, can’t sit for long, smaller children run, jump, climb constantly = restless, interrupts others, grab things from others, speak during inappropriate times, hard for the person to wait for their turn/listen

COMBINED PRESENTATION

→ ADHD C

→ symptoms of the above 2 types are equally present in the person

COURSE AND PROGNOSIS

Do not outgrow their inattentiveness but learn to adapt

Hyperactivity: less impulsive and hyperactive with age

PRESCHOOL

Main manifestation is hyperactivity

SCHOOL-AGE

Inattention becomes more prominent and impairing

ADOLESCENCE

Motoric hyperactivity becomes less obvious but difficulty with restlessness, inattention, poor planning, impulsivity persist

IF LEFT UNTREATED

Poor academic achievement, unemployment, substance abuse, unstable relationships, disorganization, low self-esteen, anxiety, depression, difficulty in learning appropriate social behaviors

COMMON ASSOCIATED CONDITIONS

→ mental disorders

1. Anxiety disorder

2. Oppositional defiant disorder

   • Negative and destructive behavior

3. Conduct disorder

   • Highly antisocial behavior

4. Bipolar disorder

5. Intermittent explosive disorder 

→ sleep disorders, tic disorders, ASD, learning disability

Oppositional defiant disorder

Negative and destructive behavior

Conduct disorder

Highly antisocial behavior

mental disorders

1. Anxiety disorder

2. Oppositional defiant disorder

   • Negative and destructive behavior

3. Conduct disorder

   • Highly antisocial behavior

4. Bipolar disorder

5. Intermittent explosive disorder

MANAGEMENT APPROACHES

→ pharmacological 

1. Stimulants: increase dopamine and norepinephrine levels

2. Non-stimulants: increase norepinephrine levels

→ developmental: OT & ST

→ behavioral and psychosocial: CBT & fam therapy

→ educational 

→ parent training and education 

Stimulants

 increase dopamine and norepinephrine levels

Non-stimulants

increase norepinephrine levels

MANAGEMENT TEAM

→ patient & family

→ developmental pediatrician

→ psychiatrists & psychologist

→ allied health professionals: OT, SLP

→ teachers

COMMUNICATION/SWALLOWING PROFILE

COGNITION			LANGUAGE
→ executive functions → attention, working memory			→ syntax: sentence formulation → narratives: often disorganized, impaired topic maintenance  → auditory processing: attending to details of a story/instructions  → semantics: word finding   → pragmatics

COGNITION

→ executive functions

→ attention, working memory

LANGUAGE

→ syntax: sentence formulation

→ narratives: often disorganized, impaired topic maintenance 

→ auditory processing: attending to details of a story/instructions 

→ semantics: word finding  

→ pragmatics

narratives

often disorganized, impaired topic maintenance

auditory processing

 attending to details of a story/instructions

semantics

word finding  

syntax

sentence formulation

SUPPORT SYSTEMS IN THE PH

The ADHD Society of the Philippines (ADHDSP)