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.
SPD: Why do you do what you do?
A motor, emotional, or verbal response to a perceived stimulus.
We misinterpret stimulus all the time, but what if you misinterpret it all of the time?
Limited motoric plans: you only know how to do something one way
Sensory processing effects…
- Development - you know how to walk and climb stairs based on sensory integration from walking and crawling
- Learning - you either learn by focusing on input or by ignoring it
- Emotional/ Behavioral - if your underwear is in a ball how does that affect you?
Sensory processing disorder will result in…
Kids being stressed by everyday “normal” activities
- sitting in class
- sand on the playground/ pencil ick
- food
Avoidance - we avoid things we don’t like
- what if you don’t like crowded places?
- temper tantrum/ behavioral problems
- quiet avoiders (tend to get less attention)
Miss milestones
- hypersensitive vestibular: might never ride a bike
Sensory reception and sensory integration are not the same thing. People with this disorder receive the information fine, but integrate it wrong.
- kids with learning diabilities and postural responses have difficulty adjusting the body in space
- reception: vision, PKS, hearing, vestibular apparatus, joints
Developmentally if sensory input is appropriate…
It is called sensory nourishment
Dependent on a sensory diet, typically and normally fed by the environment
- a good one has sensory based activities at the right intensity for the child
Good stress makes you grow and learn new things. Bad stress halts development.
If the sensory input is appropriate, the child will find it challenging, will organize it, and act on it with adaptive responses.
Sensory input has to be actie not passive. It should also be child led, not forced, and the goal is adaptive responses.
How does this help her to climb stairs and put on her shirt?
Helps with trunk control, body awareness, and balance.
Adaptive responses for SPD
You cannot force it; you can only encourage it by setting up situations that require it by grading it.
- grading makes the activity more challenging
When the system is working normally, the child will organize the information and make a goal directed adaptive response.
Adaptive responses drive development forward, resulting in new and more difficult tasks.
- The more adaptive responses the easier and the better you get.
Neural plasticity
When a child makes an adaptive response, change occurs at the neuronal synaptic level.
Adaptive responses lead to change because of neural plasticity.
- more synaptic connections, dendrites, and even increase in brain tissue size
- As a child solidifies a neural pathway, he will seek out challenges that will modify or enhance the pathway, driving development.
- Passive exposure does nothing. Active participation and adaptive responses are required.
SPD disorders
Usually not one, but a group
CNS not PNS
- sensory reception is normal, the interpretation and organization is flawed
Sensation is one of the basis for cognitive learning.
- kids with learning disabilities have more postural, vestibular, and proprioceptive problems
- many kids with ADHD have tactile processing disorders as well
What are the 3 basic SPD disorders?
- Sensory modulation disorders
- Sensory based motor disorders
- Vestibular processing
Sensory modulation disorders
The ability to tune in or tune out
Regulating sensory information for functional outcomes
Can be
- Over responsive
* “defensive”
* kick in the fight or flight mechanism
* rigid or inflexible
- under responsive
*maybe considered good babies
*lack of desire to explore or stick things in their mouths
* may be called lazy
- sensory craving or seeking
* spinner and jumpers
* dare devils
* disruptive, driven by a motor
Can affect all 7 senses
- gravitational insecurity: typically have vestibular and proprioceptive hypersensitivity; they often get low to the ground and try to flatten out when they move; they have no reason to be terrified
- postural insecurity: when you are uncomfortable doing something because you won’t be good at it; have a good reason to be uncomfortable like CP
Sensory based motor disorders
- Postural disorders
- poor balance
- low tone
- clumsy
- “I’m tired” - Dyspraxia (DCD - Developmental Coordination Disorder)
- difficulty with motor planning
- “What do i do next” or “I can’t do that”
- might over talk or fantasize, but won’t do
- copycats
- don’t know where their body is in space
- over dependent on their eyes
- cognitively on track; very clumsy
- told “go play” and reply “with what”
- good at following instructions
- no social awareness
Vestibular processing
Studies show a connection between vestibular processing and kids with learning disabilities.
- May be normal of gross tests like the Bruinicks
- Kids compensate well
- Easily overlooked because they can use proprioceptive input to keep vestibular system in check
Problems with poor
- equilibruim reactions
- low tone
* no right or left dominance
- don’t like to cross midline (crossing midline shows an intact vestibular system)
- poor bilateral skills (VBI - vestibular bilateral integration)
Functionally
- difficulty scissoring
- dressing
- jumping jacks
Post rotary nystagmus - when you spin around, your eyes should bounce back and forth for no more than a few seconds
- a hyperresponsive vestibular system has non rotary nystagmus which means you can spin around an office chair 15 times and look someone dead in the eye
Sensory discrimination
Inability or difficulty differentiating one stimulus from another
- Visual (b and d)
- Auditory (cat and hat)
- Tactile (square and circle)
Best assessed with a standardized assessment unless it’s proprioceptive.
Many different disciplines look at these.
Example:
You walk differently in a parking lot than when you’re sneaking into your house.
Diagnosing SPD.
Rule out other causes
Do parent interviews
Clinical observations
Standardized tests
- Degangi-Berk
- Miller assessment for preschooles
Multiple practitioners
Medical and surgical intervention for SPD
Meds
- often used to control symptoms
- especially hyper movement which is a hyporesponsive system
You don’t outgrow it, you just learn to adapt.
Often seen with autism and ADHD.
The #1 most effective service is
- OT sensory integrative
- can’t force it
- can’t be passive
- child led
- adaptive responses
How does SPD impact occupations?
Play
- over or under active
Relationships
ADLs
- over or under washing
IADLs
- can’t balance a checkbook
- avoid elevators or stairs
Rest and sleep
Education and work
Soft neurological signs of SPD
- poor performance in activities that are age appropriate
- don’t like things that are “normal” for their age
- reciprocal movement
- don’t cross midline
- low tone
- sensory seeking (spin, bump into stuff, shake foot, walk on toes)
- light/heavy writing
- messy eating
