ADHD

ADHD

• distinguished by persistent patterns of inattention, hyperactivity and or impulsivity

• most are diagnosed in childhood; 50% of these children continue with symptoms in adulthood 

• affects 1-5% of school aged children 

• 3-5x more likely in males

Cause of ADHD

Not typically known

possibly genetic and environmental

contributing factors: low birth weight, maternal smoking, maternal alcohol consumption, child abuse or neglect, exposure to lead

Neuroscience of ADHD

Reduced amount of norepinephrine (neurotransmitter)
• Regions of the brain involved in ADHD
• Frontal cortex
• Limited norepinephrine causes decreased attention, organization and executive function
• Limbic system
• Deficiency causes restlessness, inattention and emotional volatility
• Basal ganglia
• deficiency causes inattention and impulsivity
• Reticular activating system
• Deficiency causes inattention, impulsivity and hyperactivity

• reduced volume of prefrontal cortex, caudate and putnam of basal ganglia and cerebellum 

• less blood flow to frontal lobe, temporal lobe, parietal lobe, basal ganglia, and cerebellum

Identification of ADHD

Symptoms must be identified 

• must be presented before age 12

• consistent cross least 2 settings 

• must occur for at least 6 months 

• must impact academic, vocational and/or social functioning 

neuroimaging may show “soft” signs 

IDs of ADHD

• Family/medical history

• Continuous performance tests

• Parent Assessment

• Teacher/School assessment

Symptoms of ADHD

Decreased executive functioning, organization and time management

Inattention

Hyperactivity/impulsivity - Six or more symptoms of hyperactivity-impulsivity for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level:
• Fidgets
• Leaves seat
• Runs or climbs inappropriately
• unable to play quietly with sedentary activities
• Often on the go
• Talks excessively
• Blurts out answers
• Difficulty waiting their turn
• Often interrupts

Three types

combined presentation 

predominantly inattentive presentation 

predominantly hyperactive/impulsive presentation 

Co Morbidities

Mood Disorders

Anxiety Disorders

Substance Abuse

Conduct Disorder

Oppositional Defiant Disorder

LD

Autism

Cognitive Characteristics of Individuals with ADHD

Self regulation difficulty

memory

self directed speech

control of emotions and motivation

reconstitution or planning

Social and Emotional Characteristics 

Self esteem

social functions

Occupations and Activities affected by ADHD

Education

Social Participation

Work

Medical Management

• CNS Stimulants most effective – Ritalin and Concerta (helps 70-80%) – increases the availability of dopamine and norepinephrine at synapses
• May have side effects
• Loss of appetite
• Difficulty sleeping
• Headaches
• Irritability
• Selective norepinephrine reuptake inhibitors such as Strattera – non-stimulant
• Not usually as effective as stimulants
• School personal must not discuss medication as recommendation!!

OT Management of ADHD

• Environmental accommodations
• Decrease visual and auditory distractions
• Allow for breaks
• Allow for fidgets or movement cushions
• Music
• Scents

Behavior Management

Clear expectations
• Concise instructions
• Break down activities and expectations
• Structured routines
• Positive reinforcement
• Parent education and training
• Individual therapy
• Family therapy
• Low-Involvement Strategies
• Eye contact
• Move closer to him/her
• Place hand on his/her shoulder
• Private signal
• Give him/her a break with a chore