Unit 3 - ADHD Flashcards
definition
Average to above average intelligence
Inappropriate degrees of inattention, impulsiveness, and hyperactivity Low frustration tolerance Lack of motivation “Bores” easily Poor problem solving
Other terms associated with this disorder
minimal brain disorder (MBD), hyperkinesis, hyperkinetic impulse disorder, and hyperactive child disorder
most significant change from DSM-IV to V
Age of onset revised
“several inattentive or hyperactive-impulsive symptoms present prior to 12 years”
May NOT have causes impairment, but were just observed as present
prevalence
- most common neurodevelopmental disorder of childhood
- 3-5% among school aged children
- Male to female ratio of 4:1 to 9:1
- ~25% of children with ADHD have a learning disability
- Adults and children with ADHD are at increased risk for mood disorders such as depression or anxiety.
causes - differences in brain structure
Altered communications from the frontal lobe to other parts of the brain
Poor dopamine or norepinephrine uptake affects this communication
causes - differences in size of brain structures
Frontal lobe, basal ganglia, corpus callosum
Decrease blood flow to frontal lobe and basal ganglia
Conditions that predispose a child to develop ADD/ADHD
- Brian infections
- Inborn Errors of Metabolism
- Low Birth Weight
- Prenatal exposure to lead, alcohol, or cocaine
- Sex Chromosome abnormalities (Klinefelter syndrome, Turner Syndrome, Fragile X syndrome)
- Tourette’s Syndrome
symptoms for ADD - inattentive type
- Often fails to give attention to detail or makes careless mistakes
- Often has difficulty sustaining attention
- Often does not seem to listen
- Often does not follow through on instructions and fails to finish tasks
- Often has difficulty organizing tasks and activities
- Often avoids or dislikes tasks that require sustained mental effort
- Often loses things
- Often easily distracted
- Often forgetful
symptoms for ADHD - hyperactivity/impulsivity type
- Often fidgets or squirms
- Often leaves seat when remaining seated is expected
- Often runs about or climbs excessively in inappropriate situations
- Often has difficulty engaging in activities quietly
- Often “on the go” or “driven by a motor”
- Often talks excessively
- Often blurts out answers before questions have been completed
- Often has difficulty waiting a turn
- Often interrupts or intrudes on others
DSM # of criteria
At least 6 of 9 from category 1 (ADHD-Inattentive type) or Category 2 (ADHD-Impulsive hyperactive type) or both (ADHD-Combined type)
additional criteria
- Present for a least 6 months
- Of a degree that is maladaptive and inconsistent with developmental level
- Present before age 12
- Present in more than 1 setting
- Not due to pervasive developmental disorder or a psychotic disorder or primarily due to another mental disorder
how is a child diagnosed?
Information is gathered by parent questionnaire, teacher questionnaire
Interview with child is conducted (self-reported symptoms)
Use DSM-IV criteria to determine child is one of 3 types:
Predominantly Inattentive Type
Predominantly Hyperactive/Impulsivity Type
Combined Type
medical treatment
**Medication is most successful if used in conjunction with a behavioral program
Stimulant Treatment:
Short term efficacy in improving attention span and decreasing hyperactivity
Improvements in academic productivity and parent-child interaction
Stimulants are quick acting and improvements in behavior may be seen very shortly after child takes medication
SIDE EFFECTS: weight loss (loss of appetite), headaches, insomnia, tics (eye blinks, throat clearing)
Increase risk of substance abuse disorder (SUD)
non-conventional treatment
- vitamin/mineral supplements?
- elimination diets
evaluation of OT
- Gross motor skills and overall motor coordination for selfcare and play
- Fine motor skills, manipulation, dexterity
- Balance and postural control
- Motor planning or praxis
- Sensory registration of various stimuli (visual, auditory, tactile, vestibular)
- Attention span for functional activities
- Memory skills
- Safety and judgment for self and others
motor
High level of activity
Lack of coordination due to inattention
Clumsy, accident prone
Delayed righting and equilibrium responses
Extension patterns dominate of flexion patterns
Poor vestibular processing
motor tx
Provide motor planning opportunities
Novel activity
Reward success at each step
Work towards finishing the motor task
Increase postural control and balance responses
Flexion, flexion, flexion
Higher level righting and equilibrium response (ie. riding a bicycle)
sensory
Overly sensitive to incoming sensory stimulation (NO filtering)
Cannot maintain arousal state for learning
Affects all aspects of life: sleeping, learning, playing
sensory tx
Reduce over activity by providing calming sensory experiences
Facilitate improved response to movement against gravity (vestibular)
Increase registration of relevant sensory information
Improve ability to self-regulate own arousal state
cognitive
Short attention span, poor sustained attn.
Memory deficits
Poor problem solving (lack of task completion)
Difficulty learning new approaches
Makes quick decisions (impulsive)
cognitive tx
Challenge child to find new ways to perform a task
Work on organization
Memory cues
Facilitate problem solving by verbal guidance through task
Add novel stimuli to challenge attention and orientation
interpersonal
Poor self-control and difficulty waiting for turn
Emotional lability or mood swings
Difficulty adapting to new situations
interpersonal tx
Avoid punishment, reward target behavior, encourage child to try
Promote success and provide ways for child to try new things without failure
self-care
Difficulty completing chores, leaves tasks undone
Poor time management and difficulty completing tasks within a specified time limit
self-care tx
Use a schedule that reviews steps of task
Have child begin to set own time for task (beginning of time management skills)
Use timer
Digital watch
play
Poor exploratory skills (decreased problem solving, finishing tasks)
Jumps from one uncompleted activity to another
Tends to prefer noisy activities
play tx
Work through pretend scenarios that encourage problem solving skills
Try to incorporate peers in activities, discourage passive play alone by self
