dr tg magagula 13 august 2012. behavioral disorder: noise-making, motor driven
TRANSCRIPT
Dr TG Magagula13 August 2012
Behavioral disorder: noise-making, motor driven
Diagnosis6 or more symptoms of inattention:
careless mistakes, can’t sustain attention, doesn’t listen, can’t organize tasks, avoids schoolwork, loses things, easily distracted, forgetful.
6 or more symptoms of hyperactivity- impulsivity:Fidgeting or squirming, leaves seat, runs or
climbs excessively, cannot play quietly, on the go, talks excessively, blurts out answers, cannot await turn, often interrupts.
DiagnosisSome symptoms have been present before
age 7.Symptoms present in at least 2 settings.Impairment of academic and / or social
functioning.Not due to another Axis 1 disorder.Code subtype: -combined type for 6/12;
predominantly: inattentive for past 6/12 or hyperactive-impulsive for past 6/12
Adults/adolescents: in partial remission
Clinical FeaturesADHD may have its onset in infancy although
it is usually only diagnosed when the child is a toddler.
They have difficulty in waiting for anything and often start a task in a rush, but they have difficulty in finishing it.
Their mood is often irritable.
Clinical Features Concomitant (co-morbid) emotional-
behavioral difficulties are common.About 75% of children show aggressive and
defiant behavior fairly often.School difficulties (emotional and scholastic)
are common.
EtiologyNo single factor is known to cause ADHD:Genetic factors:
Greater concordance in monozygotic twins.Siblings have twice the risk to develop ADHD.Biological parents have higher risk for ADHD.
Developmental factors:More soft neurological deficits Brain insults: prematurity, toxins: smoking and
drinking first trimester
Co-morbidity/differential diagnosesTemperament & visual-motor-perceptual
impairments in ADHDAnxiety/depressive disordersMania bipolar I disorder wax & waneConduct disorder; ODDLearning disorders, epilepsyMental retardation(check family history)
Course and PrognosisThe course of ADHD is very variable.
Symptoms may continue into adulthood.Symptoms may fully remit.Hyperactivity may disappear while attention
problems persist.Persistence is predicted by:
Family history, negative life events, punitive, harsh parenting, co morbidity.
Treatment: Bio psychosocial (MDT)Comprehensive treatment program indicatedNot all children need medsDecision to use meds based on thorough
assessment of severity, impact and developmental appropriateness of symptoms
Stimulants: Methylphenidate RitalinNon-stimulants include: Atomoxetine-
Strattera, Modafinil-Provigil
Cognitive-behavioral approach:
Train skills: self-instruction, -evaluation,-monitoring, anger management, social behavior. Problem solving skills
Evaluation and treatment of co morbid psychiatric disorders; child and parent(s)
Inform child about purpose of medsTalk about “I am crazy” Family therapy
Social interventionSocial skills groups.Training, assessment and treatment of parents.
Expectations and behavioral programs.Parents and teachers work together to structure
environment with set of expectations and rewards.
Behavioral interventions at home & school (star chart)
ConclusionConcerns:
Inappropriate dx -/under dx of ADHD & prescription of ADHD medication.
“Best researched disorder in medicine”Multiple agents and therapies are
necessary to treat ADHD and co-morbidity; prevent disability.