ADHD & SPD Flashcards
ICD 10 code for ADHD
F90.1
What is ADHD?
- Attention Deficit Hyperactivity Disorder
- It is a neurobiological/ neurodevelopmental disorder, with symptoms occurring before 12 and not the result of other issues.
- Children do not outgrow it. They just figure out a way to do things in a way that works for them.
- Should be diagnosed by neurologist, but is often diagnosed by psych or PhD.
What are the characteristics of ADHD?
Inattention
Hyperactivity
Impulsivity
- Children under 17 must have 6 symptoms in the category(s)
- Over 17 must have 5 because by the time you’re 17, you’ve figured out ways to be successful despite your symptoms
- Symptoms must have occurred for at least 6 months.
Hyperactivity and Impulsivity Symptoms
- Often fidget or tap hands to feet or squirms in seat.
- Often leaves seat in situation when remaining seated is expected.
- Often runs about or climbs in situations where it is inappropriate.
- Often unable to play or engage in leisure activities quietly.
- Is often on the go and acting as if driven by a motor.
- Often talks excessively.
- Often blurts out an answer before a question has been completed.
- Often interrupts or intrudes on others
- Often has difficulty waiting their turn.
Inattention Symptoms
- Often fails to give close attention to details or makes careless mistakes.
- Often has difficulty sustaining attention in tasks or play activities.
- Often does not seem to listen when spoken to directly.
- Often does not follow through on instruction and fails to finish duties.
- Often has difficulty organizing tasks and activities.
- Often avoids tasks that require sustained mental effort.
- Often loses things necessary for tasks or activities.
- Is often easily distracted by extraneous stimuli.
- Is often forgetful in daily activities.
Etiology and incidence of ADHD
Multifactorial
- Genetic and environmental
- Chemical
- Injury
Diagnosis has significantly increased in the past 20 years because we now know what we are looking for.
7-11% of all children have it. Boys are 5x more likely to be diagnosed because their behaviors are louder, like being class clown, and they rough house.
4-5% of adults are diagnosed because they have coping mechanisms and compensatory methods already in place.
Diagnosis and comorbid conditions of ADHD
No single biological marker
We all have some of the symptoms.
Diagnosis should be:
- from multiple sources: doctor, teachers, parents; often involved questionnaires
- rule out other possible issues
- review medical and educational records
Often seen in conjugation with other disorders such as: developmental coordination disorder, autism, OCD
Increased in children with substance abuse history (mom used alcohol or drugs) and head injuries.
Prognosis of ADHD
Lifelong disorder
- importance of the right path to “harness energy”
- lower number is higher education
- higher drop out rate
- poorer driving records
Interventions for ADHD
Pharmacological
- most common
- not a magic bullet
- stimulants for “tazmanian devils” to increase the amount of dopamine and norepinephrine which causes a calming effect
* concerta, ritilan, vyvanse, adderall
* hyporesponsive so stimulant calms
- non-stimulant
• atomozetine, clonidine
* effective if stimulants don’t work
* side effects: feeling sluggish and losing appetite
Cognitive Behavioral Therapy (CBT)
- doesn’t work for younger children
- works well with high IQ
- “stop and think”
- using a planner
- walking away when stressed
- meta-cognitive therapy
* used with older children and adults to help recognize how your body feels and what to do about it
* reflection and self evaluation
Mindfulness
- type of metacognitive therapy
- incorporate meditation and physically trying to slow breathing and anxiety
- being very aware of your surroundings and patterns of thought
Coaching
- similar to mindfulness
- goal-oriented
- having an outside voice of reason
Role of parent to child with ADHD
- it is real, not something they are doing on purpose or if they just try harder. Medication AND parent training = more success
- positive enforcement
- flexibility and rigidity
- goal setting
- rehearsal
- positive review
Tips for parents of children with ADHD
Keep it interesting
Praise and encourage
Break it down
Provide structure
Encourage exercise (proprioceptive)
Sleep hygiene (no screen)
Keep distractions to a minimum
Think out loud
Explain don’t command
Take breaks
Pick your battles
Remember children aren’t adults and they all act up
Classroom for children with ADHD
Kids spend much of their lives in school
- Declutter
Some kids will need an IEP
Many of the same strategies for parents
Headphones
Front of the classroom
Quiet area for testing
Frequent breaks
Mix physical and seat work
How can ADHD impact occupations?
ADLs
- often disrupted
- charts, check offs
- setting a routine
- giving lots of time
IADLs
- lists and schedules of tasks
Health management
- routine for meds
Sleep and rest
- tough one
- screens
- black out curtains
- quiet or white noise
Work
- lists, calendars
- selection of job
Play, leisure, and social
- often have issues with friends
- peer groups
- prep for play
- short duration
- interesting
- quiet play
ICD 10 code for sensory processing disorder
F88
What was A. Jean Ayres’ role in sensory development disorder?
She was an OT and developmental psychologist.
Defined sensory integration as organization of sensory information for use in functional occupations.
ASI (ayres sensory integration) is a trademarked form of intervention.
What is sensory integration?
The ability to select (automatically) a useful input, organize it, and accomplish a goal (in a split second); thuse, leading to an adaptive response (new skill) and competent praxis (coordinated movement).
Children who have autism often have difficulty producing an adaptive response.
What are the senses?
Touch (tactile)
Sight (visual)
Sound (auditory)
Taste (gustatory)
Smell (olfactory)
Vestibular
Proprioceptive
Interoceptive
Vestibular sense
The inner ear detects linear and circular motion
Head position
Arousal, regulation, postural control, bilateral coordination
Linked to vagus nerve: overstimulation = panic; understimulation = not registering information, going to sleep
Anytime you leave the ground
Balance and motion
Knowing right from left
Proprioceptive sense
Where we are in space and how much we need (chick vs $100)
Velocity and force
From the joints, muscles and tendons - “mechanosensory neurons”
Pounding or getting smushed
Body awareness
Interoceptive sense
The awareness of your own body
The ability to calm down or get loud even if you don’t want to
Emotional and attentional regulation
Look at each complain and match it to the sense and tell if it is hypo or hyper
Poo gross motor – hypoproprioceptive
Tip toes – hypoproprioceptive (you get more proprioceptive input)
Focusing - hypo vestibular and proprioception
Chew – hypo tactile, gustatory,
Hypoproprioceptive – handwriting
Dressing – hypotactile, proprioceptive, vestibular
Proprioceptive – w position
Etiology of SPD
No specific cause, but is neurobiological
Maternal stress
Trauma
- maternal/ early abuse
Alcohol
Multiple factors
- LBW
- Maternal illness and medication
- single parent
- smoking/ alcohol/ drug use
Incidence of SPD
1/20 kids
Only an issue when it affects function
75% of kids with autism
What is sensory input?
SI is neurobiologically based.
Appropriate SI is necessary for optimal brain function.
- Too much or not enough will cause the brain to malfunction, shutdown, or distort.
- It has a a strong effect on cognition and social.
