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some information of attention deficit/hyperactivity disorder
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adHD powerpoint
- 2. What is Attention- Deficit/ Hyperactivity Disorder (ADHD)?
- 4. Inattention Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities. Often has trouble holding attention on tasks or play activities. Often does not seem to listen when spoken to directly. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked). Often has trouble organizing tasks and activities. Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework). Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones). Is often easily distracted Is often forgetful in daily activities â§6 symptoms of inattention for childrenâŠ16y/o, or ⧠5 symptoms for adolescents > 17y/o and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level
- 5. Hyperactivity/ Impulsivity Often fidgets with or taps hands or feet, or squirms in seat. Often leaves seat in situations when remaining seated is expected. Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless). Often unable to play or take part in leisure activities quietly. Is often "on the go" acting as if "driven by a motor". Often talks excessively. Often blurts out an answer before a question has been completed. Often has trouble waiting his/her turn. Often interrupts or intrudes on others (e.g., butts into conversations or games) ⧠6 symptoms for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the personâs developmental level
- 6. DSM-5 Criteria People with ADHD show a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development Symptoms of Inattention Symptoms of Hyperactivity and Impulsivity In addition, the following conditions must be met: âąSeveral inattentive or hyperactive-impulsive symptoms were present before age 12 years. âąSeveral symptoms are present in two or more setting, (e.g., at home, school or work; with friends or relatives; in other activities). âąThere is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning. âąThe symptoms do not happen only during the course of schizophrenia or another psychotic disorder. The symptoms are not better explained by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).
- 8. ćć° 9.9% 1993 ć°äžć°äș 6.3% 2003 7-12y/o 8.4% 2002 1070ćäžç 2005 7.5%
- 11. ADHD is one of the most common neurodevelopemental disorders of childhood. USA CDC website
- 12. The age of attaining peak cortical thickness in children with ADHD compared with typically developing children. Shaw P et al. PNAS 2007;104:19649-19654 Delay cortical maturation
- 13. Toward Systems Neuroscience of ADHD: A Meta- Analysis of 55 fMRI Studies (Am J Psychiatry 2012; 169:1038â1055)
- 14. Hypoactivation in ADHD relative to comparison subjects was observed mostly in systems involved in executive function (frontoparietal network) and attention (ventral attentional network).
- 16. J Psychiatr Res. 2011 Predictors of Persistent ADHD: An 11-year Follow-up Study Joseph Biedermana,*, Carter R. Pettya, Allison Clarkea, Alexandra Lomedicoa, and Stephen V. Faraoneb a Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School b Departments of Psychiatry and Neuroscience & Physiology, SUNY Upstate Medical University Abstract ObjectiveâDespite the existence of several follow-up studies of children with ADHD followed up into adulthood, there is limited information on whether patterns of persistence and remission in ADHD can be predicted over the long-term. The main aim of this study was to evaluate predictors of persistence of ADHD in a large sample of boys with and without ADHD followed prospectively for 11 years into young adulthood. MethodâSubjects were Caucasian, non-Hispanic boys with (N=110) and without (N=105) ADHD who were 6 to 17 years old at the baseline assessment (mean age 11 years) and 15 to 31 years old at the follow-up assessment (mean age 22 years). Subjects were comprehensively and blindly assessed with structured diagnostic interviews and assessments of cognitive, social, school, and family functioning. ResultsâAt the 11-year follow-up, 78% of children with ADHD continued to have a full (35%) or a partial persistence (subsyndromal (22%), impaired functioning (15%), or remitted but treated (6%)). Predictors of persistence were severe impairment of ADHD, psychiatric comorbidity, and exposure to maternal psychopathology at baseline. ConclusionsâThese findings prospectively confirm that persistence of ADHD over the long term is predictable from psychosocial adversity and psychiatric comorbidity ascertained 11 years earlier. Keywords ADHD; persistence; predictors; longitudinal; young adult Corresponding Author: Joseph Biederman, M.D. Massachusetts General Hospital, Pediatric Psychopharmacology Unit, 55 Fruit Street, YAW 6A-6900, Boston, MA 02114; phone: 617-726-1731; fax: 617-724-3742; jbiederman@partners.org. Conflicts of interest: Dr. Joseph Biederman is currently receiving research support from the following sources: Alza, AstraZeneca, Bristol Myers Squibb, Eli Lilly and Co., Janssen Pharmaceuticals Inc., McNeil, Merck, Organon, Otsuka, Shire, NIMH, and NICHD. In 2009, Dr. Joseph Biederman received a speakerâs fee from the following sources: Fundacion Areces, Medice Pharmaceuticals, and the Spanish Child Psychiatry Association. In previous years, Dr. Joseph Biederman received research support, consultation fees, or speakerâs fees for/from the following additional sources: Abbott, AstraZeneca, Celltech, Cephalon, Eli Lilly and Co., Esai, Forest, Glaxo, Gliatech, Janssen, McNeil, NARSAD, NIDA, New River, Novartis, Noven, Neurosearch, Pfizer, Pharmacia, The Prechter Foundation, Shire, The Stanley Foundation, UCB Pharma, Inc. and Wyeth. -PAAuthorManuscriptNIH-PAAuthorManuscriptNIH-PAAuthorManuscrip ADHD: 110äșș Control 105äșș 78% Persistence Impaired function Remitted but treated
- 19. ć ±ç ç
- 20. Disruptive behavior disorder Mood disorders Anxiety disorders tics and Tourette Syndrome Learning Disabilities Substance abuse
- 21. Tics, Tourette syndrome 7% éćçć ç«„ æTICSæ抄çç 60%抄ççć ç«„ æéćç
- 23. Mood Disorder 10-30% ć°ć© 47% æäșș æ鏱 èșç, éæ„”ç 20% of individual with ADHD
- 24. Anxiety Disorder Up to 30% ć°ć© 25-40% æäșș ć°RitalinæČ»çćæèŒäžć„œ (30% VS 70-80%)
- 25. Disruptive Behavior Disorder 40% Conduct Disorder 25%ć ç«„ 40-50% éć°ćčŽ 20-25% æäșș Oppositional Defiant Disorder
- 26. Substance abuse
- 29. Headache, abd pain Decreased appetite, sleep disorder
- 31. 579 ADHD combined type(7-10y/o) Follow-up 14 mo Arch Gen Psy 1999 Hyperactive-impulsive symptoms Parent-Child Arguing Social skills Internalizing symptoms
- 32. Combined therapy Improvements in academic performance Reductions in conduct problems Higher levels of parental satisfaction Lower doses of stimulant medication Superior for treating children of low socioeconomic status Superior for treating children with coexisting anxiety
- 33. What can the physician do ? AAP 2011 clinical practice guideline
- 35. 4-18 y/o Academic or Behavioral Problem Initiate ADHD evaluation Inattention, Hyperactivity, Impulsivity +
- 37. To make a diagnosis of ADHD, Meet DSM- V criteria Obtain report from parents, guardian, teachers, and other school and mental health clinicians Any alternative cause
- 38. Preschoolaged Children (4 â5 Years Old) challenges in determining the presence of key symptoms
- 39. Adolescents Try to obtain (with agreement from the adolescent) information from at least 2 teachers as well as information from other sources such as coaches, school guidance counselors, or leaders of community activities in which the adolescent participates Establish the younger manifestations of the condition that were missed Consider strongly substance use, depression, and anxiety as alternative or co-occurring diagnoses.
- 40. Assess for other conditions that might coexist with ADHD, including Emotional or behavioral condition (eg, anxiety, depressive, oppositional defiant, and conduct disorders), Developmental conditions (eg, learning and language disorders or other neurodevelopmental disorders) Physical conditions (eg, tics, sleep apnea)
- 41. Recognize ADHD as a chronic condition
- 42. Treatment vary depending on the patientâs age. Preschoolaged children (4â5 y/o) Elementary school-aged children (6â11 y/o) Adolescents (12â18 y/o) Medication Behavior therapy Medication Medication Behavior therapy Behavior therapy
Hinweis der Redaktion
- Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities. Often has trouble holding attention on tasks or play activities. Often does not seem to listen when spoken to directly. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked). Often has trouble organizing tasks and activities. Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework). Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones). Is often easily distracted Is often forgetful in daily activities
- Often fidgets with or taps hands or feet, or squirms in seat. Often leaves seat in situations when remaining seated is expected. Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless). Often unable to play or take part in leisure activities quietly. Is often "on the go" acting as if "driven by a motor". Often talks excessively. Often blurts out an answer before a question has been completed. Often has trouble waiting his/her turn. Often interrupts or intrudes on others (e.g., butts into conversations or games)
- The age of attaining peak cortical thickness in children with ADHD compared with typically developing children. (A) dorsal view of the cortical regions where peak thickness was attained at each age (shown, ages 7â12) in ADHD (Upper) and typically developing controls (Lower). The darker colors indicate regions where a quadratic model was not appropriate (and thus a peak age could not be calculated), or the peak age was estimated to lie outside the age range covered. Both groups showed a similar sequence of the regions that attained peak thickness, but the ADHD group showed considerable delay in reaching this developmental marker. (B) Right lateral view of the cortical regions where peak thickness was attained at each age (shown, ages 7â13) in ADHD (Upper) and typically developing controls (Lower). Again, the delay in ADHD group in attaining peak cortical thickness is apparent.
- 39 children, 16 for adult Children: hyperactivation was observed in the right angular gyrus, middle occipital gyrus, posterior cingulate cortex, and midcingulate cortex
- 6-17Y/O
- The most careful studies suggest that between 10-30 percent of children with ADHD, and 47 percent of adults with ADHD, also have depression The antidepressant desipramine (Norpramin) has improved both ADHD and ADHD and depression Researchers have also found that stimulants (such as Ritalin) can be combined safely with antidepressants such as fluoxetine (Prozac) Newer antidepressants such as bupropion (Wellbutrin) and venlafaxine (Effexor )
- ćŠäčćć»șè°ïŒæčçœćșăæžć°æćăçšæŽç°ĄćźçéĄèČïŒæ©èČèŠć°ćżćïŒćŠææéć ©çšźçæłïŒć°±èŠéČć „çŽ èČïŒéć§è©äŒ°æŻćŠæ ADHDïŒèçŽ èČèäœ çć°ćæŸć€§éĄæŻäžæšŁçéĄèČă
- the primary care clinician should determine that Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV-TR) criteria have been met (including documentation of impairment in more than 1 major setting), and information should be obtained primarily from reports from parents or guardians, teachers, and other school and mental health clinicians involved in the childâs care. The primary care clinician should also rule out any alternative cause.
- challenges in determining the presence of key symptoms Physicians may recommend that 1. parents complete a parent-training program before confirming an ADHD diagnosis for preschool-aged children and 2. consider placement in a qualified preschool program if they have not done so already. the use of validated DSM-IVâ based ADHD rating scales
- clinicians need to try to obtain (with agreement from the adolescent) information from at least 2 teachers as well as information from other sources such as coaches, school guidance counselors, or leaders of community activities in which the adolescent participates it is important to establish the younger manifestations of the condition that were missed and to strongly consider substance use, depression, and anxiety as alternative or co-occurring diagnoses. Adolescents with ADHD, especially when untreated, are at greater risk of substance abuse.