Adhd presentation

2. of childhood, among the most prevalent chronic
health conditions affecting school-aged children, and
the most extensively studied mental disorder of
childhood.
ADHD is characterized by inattention, including
increased distractibility and difficulty sustaining
attention; poor impulse control and decreased self-
inhibitory capacity; and motor over activity and
motor restlessness.
INTRODUCTION
:
ADHD is the most common neurobehavioral disorder

3. • academic underachievement,
• problems with interpersonal relationships
with
• family members and peers.
• low self-esteem.
Affected children commonly experience
ADHD often co-occurs with other emotional,
behavioral, language, and learning disorders

4. Diagnosing ADHD: DSM-V
Inattention
:
(A1
)
• Lacks attention to detail; makes
careless mistakes.
• has difficulty sustaining attention
doesn’t seem to listen.
• fails to follow through/fails to
finish instructions or schoolwork.
has difficulty organizing tasks.
avoids tasks requiring mental
effort.
• often loses items necessary for
completing a task.
• easily distracted.
• is forgetful in daily activities.
Persisted for at
least 6 months to a
degree that is
inconsistent with
developmental
level and that
negatively impacts
directly on social
and
academic/occupati
onal activities

5. Diagnosing ADHD: DSM-V
Hyperactivity,
Impulsivity (A2)
• Fidgets or squirms excessively.
• leaves seat when inappropriate
runs out.
• difficulty playing quietly
• talks excessively
• cannot wait tern
• blurts out answer is finished
• is forgetful in daily activities.
• cuts other people conversation
Persisted for at
least 6 months to a
degree that is
inconsistent with
developmental
level and that
negatively impacts
directly on social
and
academic/occupati
onal activities

6. B.Several inattentive or hyperactive-impulsive
symptoms were present prior to age 12 years.
C.Several inattentive or hyperactive-impulsive
symptoms are present in two or more settings.
D.There must be clear evidence of clinically significant
impairment in social, academic, or occupational
functioning.
E.Symptoms do not occur exclusively during the
course of a pervasive developmental disorder,
schizophrenia, or other psychotic disorder, and are
not better accounted for by another mental
disorder (e.g., mood disorder, anxiety disorder,
dissociative disorder, personality disorder).
Diagnosing ADHD: DSM-V

7. Specify whether:
•Combinedpresentation: If both Criterion A1
(inattention) and Criterion A2 (hyperactivity-
impulsivity) are met for the past 6 months.
•Predominantly inattentive presentation: If Criterion
A1 (inattention) is met but Criterion A2
(hyperactivity-impulsivity) is not met for the past 6
months.
•Predominantly hyperactive/impulsive presentation:
If Criterion A2 (hyperactivity-impulsivity) is met and
Criterion A1 (inattention) is not met for the past 6
months.

8. Specify if:
•In partial remission: When full criteria were
previously met, fewer than the full criteria have been
met for the past 6 months, and the symptoms still
result in impairment in social, academic, or
occupational functioning.

9. A Possible Developmental Pathway for
ADHD

10. EPIDEMIOLOGY:
• Studies of the prevalence of ADHD across the
globe have generally reported that 9% of
school- age children are affected, although
rates vary considerably by country.
• The prevalence rate in adolescent samples is 2-
6%.

11. ETIOLOGY
:
•
•
No single factor determines the expression of ADHD;
Mothers of children with ADHD are more likely to
experience birth complications, such as toxaemia,
lengthy labour, and complicated delivery.
•Maternal smoking and alcohol use during pregnancy
and prenatal or postnatal exposure to lead are
commonly linked the development of ADHD.
•There is a strong genetic component to ADHD.
[dopamine transporter gene (DAT1)and a particular
form of the dopamine 4 receptor gene (DRD4)].
There are some other genes that might contribute to
ADHD

12. DIFFERENTIAL DIAGNOSIS
• Oppositional Defiant Disorder
Individuals with oppositional defiant disorder may resist
work or school tasks that require self-application because
they resist conforming to others' demands. Their behavior is
characterized by negativity, hostility, and defiance.
• Intermittent Explosive Disorder
ADHD and intermittent explosive disorder share high levels
of impulsive behavior. However, individuals with
intermittent explosive disorder show serious aggression
toward others, which is not characteristic of ADHD, and they
do not experience problems with sustaining attention as seen
in ADHD.
• Specific learning and intellectual disability disorder
When children face difficult or inappropriate task according
to academic setting their in attentive behaviors increases.

13. •
•
Depression and anxiety disorders can cause many
of the same symptoms as ADHD, but can also be
comorbid conditions.
Obsessive-compulsive disorder can mimic ADHD,
particularly when recurrent and persistent thoughts,
impulses, or images are intrusive and interfere with
normal daily activities.
Post Traumatic Stress Disorder
Some major life stresses such as death of a close
family member, parents’ divorce, family violence,
parents’ substance abuse, a move can cause symptoms
like restlessness, irritability, in attention poor
concentration in children younger than 6 years.
.
•

14. DIFFERENTIAL DIAGNOSIS
• Chronic illnesses, such as migraine headaches, absence
seizures, asthma and allergies, hematologic disorders,
diabetes, childhood cancer, can impair children's attention
and school performance, either because of the disease itself
or because of the medications used to treat or control the
underlying illness (medications for asthma, steroids,
anticonvulsants, antihistamines) .
• In older children and adolescents, substance abuse can
result in declining school performance and inattentive
behavior.
• Autism spectrum disorder and bipolar disorder They
share some same symptoms but in autism inattention is
because of resistance to change and in bipolar it lasts less,
occurs in form of episodes.

15. Lower activity in brain regions associated
with executive function
(particularly abnormalities in
Frontostriatal circuit):
• Prefrontal cortex
• Basal ganglia
• Cerebellum(vermis)
These areas of the brain are associated with executive function abilities:
such as Attention, spatial working memory, and short-term
memory and Response inhibition and set shifting.
PATHOGENESIS

16. DIAGNOSIS
:
•
A diagnosis of ADHD is made primarily in clinical
settings after a thorough evaluation, including
–a careful history and clinical interview to rule in or
to identify other causes or contributing factors;
–completion of behavior rating scales;
–a physical examination;
–any necessary or indicated laboratory tests.
It is important to systematically gather and evaluate
information from a variety of sources, including the
child, parents, teachers, physicians, and when
appropriate other caretakers.
•

17. Clinical Interview and
History:
A family history of 1st-degree relatives with ADHD,
mood or anxiety disorders, learning disability,
antisocial disorder, or alcohol or substance abuse
conditions)
History of the presenting problems, growth and development,
pregnancy complications, such as maternal illness
(eclampsia, diabetes),
maternal smoking, alcohol, or illicit drug use.
The perinatal period--presence of labor problems, delivery
complications, prematurity, jaundice, and low
birth weight.
Disruptive social factors, such as family discord,
situational stress, and abuse or neglect.
(indicate an increased risk of ADHD and/or comorbid

18. Behavior Rating Scales:
•
o Behavior rating scales are useful in establishing the
magnitude of the symptoms, but are not sufficient
alone to make a diagnosis of ADHD.
o Many scales available
–Conners Comprehensive Behavior Rating Scales
(Conners CBRS)--

19. PHYSICAL EXAMINATION AND LABORATORY
FINDINGS
• Exploration of cardiac status as well as monitoring of
height and weight.
• identify any possible vision or hearing problems.
• testing for elevated lead levels in children those who
are exposed to environmental factors that might put
them at risk (substandard housing, old paint).

20. Comorbiddisorders
:
Prevalence of comorbid disorders for children with
ADHD vs those without

21. PROGNOSIS
•
•
•
difficulties, and relationship difficulties.
From 60-80% of children with ADHD continue to
experience symptoms in adolescence, and up to 40- 60% of
adolescents exhibit ADHD symptoms into adulthood.
In children with ADHD, a reduction in hyperactive
Behavior often occurs with age. Other symptoms
become more prominent with age, such as
inattention, impulsivity, and disorganization.
A variety of risk factors can affect children with
untreated ADHD as they become adults. These risk
factors include engaging in risk-taking behaviors
(sexual activity, delinquent behaviors, substance use,
Employment

22. TREATMENT
: No treatments have been found to cure this disorder,
but symptoms of disorder can be managed.
Psycho social treatments
The parents and child should be educated with
regard to the ways ADHD can affect learning, behavior,
self-esteem, social skills, and family function.
•The clinician should set goals for the family to
improve the child's interpersonal relationships,
develop study skills, and decrease disruptive
behaviors.

23. Behavioral Treatment Components
•Psychoeducation about ADHD
•Structure/routines
•Clear rules/expectations
•Attending/rewards
•Planned ignoring
•Effective commands
•Time out/loss of privileges •Point/token
systems
•Daily school-home report card
•Intensive summer treatment programs

24. Behaviorally Oriented Treatments
:
•The goal of such treatment is for the clinician to
identify targeted behaviors that cause impairment in
the child's life (disruptive behavior, difficulty in
completing homework, failure to obey home or
school rules)
•The clinician should guide the parents and teachers
in implementing rules, consequences, and rewards to
encourage desired behaviors.
•Behavioral interventions are only modestly
successful at improving behavior, but they may be
particularly useful for children with complex
Comorbidities and family stressors, when combined
with medication.

25. Medications :
The most widely used medications are the Psychostimulant
medications
• Over the first 4 week of treatment, the physician should
increase the medication dose as tolerated (keeping side
effects minimal to absent) to achieve maximum benefit.
• If this strategy does not yield satisfactory results, or if side
effects prevent further dose adjustment in the presence of
persisting symptoms, the clinician
should use an alternative class of stimulants that
was not used previously.
• If satisfactory treatment results are not obtained
with the second stimulant, clinicians may choose to
prescribe atomoxetine, a noradrenergic reuptake
inhibitor. .

26. PREVENTION
Parent training can lead to significant
improvements in
preschool children with ADHD symptoms, and
parent
training for preschool youth with ADHD can reduce
oppositional behavior.

27. THANK
YOU