Dr. Chavda's presentation at Tata Learning Disability Forum (TLDF), 2013.
The Forum for Learning Disabilities centred on the theme ‘Learning Disabilities – a more inclusive perspective’. The forum this year included in its purview three additional Learning Disabilities (LD), namely Specific Learning Disability (SpLD), Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD).
In line with the TATA Group’s corporate sustainability endeavors, TIS initiated the Tata Learning Disability Forum (TLDF) in 2006 to ensure that students with special education needs receive the required attention as well as to spread awareness about LD which had been receiving scant attention in India. Since then, via the TLDF platform, TIS has been successful in generating an increased level of awareness and enabling progress in remediation activities for students with LD.
2. FACT:
ADHD is a clinical diagnosis with no specific
validated biological or cognitive tests.
3. EVALUATION SHOULD IDEALLY INCLUDE
Interview with parents to evaluate developmental,
medical and family history, and assess family
functioning
Interview with child to assess physical disorder, co
morbid mood disorder, tic disorder, anxiety disorder,
substance use disorder or speech or language
problems
4. NOTE THAT…
Patients with ADHD, either youth or adult, tend to
under report their ADHD symptoms, so
collaborative history is helpful
5. CHECK OUT:
Medical problems e.g. endocrinopathy,
environmental exposure
Neurological disorders e.g. petit mal epilepsy or
complex partial seizures
Collateral information from school, including school
rating scales
Specific Rating scales for parents and teachers
6. ASSESSMENT SCALES FOR ADHD
DSM IV scales
Connors Rating Scale –Revised
These have demonstrated high sensitivity and
specificity for differentiating between children with
ADHD and aged-matched community controls
7. LAB TESTS:
Lead levels(not common)
Thyroid function tests
Vit B12 levels
Vit D3 levels
Iron deficiency
EEG
Neuro –imaging
Genetic testing
8. SPECIALIST CONSULTATION
Us e the services of a Neuro-developmental
Paediatrician , neurologist, psychiatrist,
psychologist, Occupational Therapist
Rarely hospitalize if the patient is a danger to
himself or to another
12. FACT:
The Multimodal Treatment Study for ADHD
suggested that stimulant medication is a
reasonable first-line treatment for most children with
ADHD.
However, concomitant psycho-socio-behavioural
interventions are also indicated.
13. NON- DRUG THERAPY
Behaviour Therapy:
As an adjunct to drug therapy
Alone as initial therapy in very young
children or those with mild symptoms or if there is a
disagreement about the diagnosis
14. ASPECTS OF BEHAVIOUR THERAPY
Information and the natural history of the condition
Learning to observe the child's appropriate and
inappropriate behaviour more carefully
Using a home “Token economy” system
effectively…positive and negative reinforcements
15. ALSO
How to use “Time out” effectively
How to manage non-compliant behaviours in public
Learning to avoid future behavioural catastrophes
16. YOU NEED TO
take individual differences in co morbid mental
health issues and behavioural problems, functional
impairments and family issues ,into account while
designing appropriate interventions
17. NOTE
There is no evidence to support the use of CBT,
Play Therapy or dietary modifications in the
treatment of ADHD in children.
However, there is evidence to support the use of
CBT with drug therapy in the treatment of adults
with ADHD.
18. TEACHERS ROLE
Individualize intervention plans to meet the specific
needs of the child
Identify antecedents and consequences of their
classroom behaviours
Clearly state class-room rules
Provide a structured learning environment
Review the rules every day
19. IMPORTANT
Give feedback to the student frequently
Provide consistent consequences
Provide positive feedback for good behavior and
ignore mild inappropriate ones
Preferential seating
Divide longer assignments into smaller discrete
pieces
Use a token economy system
20. ALSO
Use “Time-out” appropriately
Consider interventions like use of a buddy/peer
tutoring
Use of concessions laid down by the various
Boards of education
21. USE OF OCCUPATIONAL THERAPY
This is known to benefit kids who have
ADHD….done on a long term basis.
It can be used individually or in a group situation
24. SPECIFIC RECOMMENDATIONS:
Explain ADHD to parents and their families
Encourage patients to reach their individual
treatment goals
Explain the rationale of specific behavioural
modifications
Explain drug therapy>>>why? How long? Dosage?
Side-effects
25. ALSO
Read…but remember that Dr Google is not a doctor
Join support groups or start them in your area
Follow-up/ monitor patients regularly
26. HOWEVER…
Pharmacological or psychotherapeutic treatment of
co morbid psychiatric disorders may need to be
initiated first if they are significantly impairing…e.g.
mood disorders or tic disorders