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Attention-Deficit/ Hyperactivity Disorder (ADHD) - Coggle Diagram
Attention-Deficit/ Hyperactivity Disorder (ADHD)
Definition
attention-deficit
Inability to sustain focus.
hyperactivity
An excess movement that is not fitting to the setting, including impulsivity.
disorder
A condition characterized by lack of normal functioning of physical or mental processes.
Prevalence & Causes
Prevalence of ADHD
Male> Female
10.2%
among children
4.4% among adults
Prevalence of ADHD among HL population
in children population
hereditary HL
30.7%
Acquired HL
20.0%
prevalence of ADHD in school-aged children with hearing loss is higher than that in the general population of the same age
Causes?
Genetics
other possible causes
alcohol and tobacco use during pregnancy
Exposure to environmental toxins (e.g., lead) during pregnancy or at a young age
Premature birth
low birth weight
TBI early in life
Management
Behavior Therapy
Parents Training in Behavior Management
Provides education to improve their understanding about ADHD, behavioral problems, and child development
Peer Intervention
Include social skills training and time-intensive, adult-mediated interactions to improve social behaviors.
Behavioral interventions in the classroom
Focuses on strategies to improve classroom routines and structure
A token economy
To shape positive behaviors
A daily behavioral report card
To monitor progress and provide feedback to the child, parent, and team.
Medication
Stimulants
methylphenidate and dextroamphetamine
Most effective for the treatment of core ADHD symptoms and have generally acceptable adverse effect profiles
Methylphenidate should be offered to children aged ≥6 years and adolescents with attention-deficit/hyperactivity disorder (ADHD) if medication is indicated.
If medication for ADHD is indicated in children <6 years old, it should be initiated by a child psychiatrist or a paediatrician with expertise in managing ADHD.
Non Stimulants
Atomoxetine (Strattera)
Clonidine (Catapres, Kapvay)
Guanfacine (Intuniv)
Occupational Therapy
Cognitive interventions
cognitive orientation to daily occupational performance (CO-OP) improved motor performance
Motor interventions
three-dimensional fine motor training significantly improved speed and consistent letter shapes in handwriting
Sensory interventions
weighted vests improved attention and on-task behaviour
stability balls improved in-seat and on-task behaviour
Play based interventions
reduced ADHD symptoms and, enhanced relationships and child’s overall performance
improved playfulness and interpersonal empathy
Parent-delivered intervention increased play skills
social skills training improved communication, interactions skills and improve process skills
Monitoring
Healthcare providers should provide continued care and long term monitoring to children and adolescents with ADHD
Combination Treatment
combination of pharmacotherapy and behavioural therapy in ADHD
allows for the use of lower stimulant dosages
may reduce risk of medication-related side effects
should be considered in children ≥6 years of age and adolescents with ADHD when the symptoms persist and cause functional impairment
ADHD
VS
CAPD
Similarities
Both have problems carrying out multi-step directions
Both have poor listening skills
Both have trouble paying attention to and remembering information presented orally
Both have difficulty with reading, comprehension, spelling, and vocabulary
Both have behavior problems
Both needs more time to process information
Differences
The main difference between ADHD and APD is that people with APD will show more difficulties with tasks involving sound.
ADHD
Easily distracted by whatever’s going on
(in any environment)
— sounds, sights, activity
CAPD
Easily distracted by background noise or loud and sudden noises.
Do not have difficulty focusing and paying attention in quiet environments
.
Children with ADHD usually exhibit
no clear pattern on auditory processing tests
and inconsistencies in APD test performance opposite with CAPD
ADHD
Poor executive functioning
is the primary clinical concern
CAPD
Executive dysfunction has been reported as a
secondary parameter
in CAPD because the auditory perceptual deficits impede the operation of executive functions.
Characteristic
In children
noticeable before age 6
occur in more than 1 situations
Inattentiveness (difficulty in concentrating and focusing)
Short attention span and easily distracted
Making careless mistakes
Forgetful or losing things
Unable to strict to tedious tasks or time-consuming
Unable to listen or carry out instruction
Constantly chancing activity or task
Difficulty in organising task
hyperactive and impulsiveness
being unable to sit still, especially in calm or quiet surroundings
constantly fidgeting
being unable to concentrate on tasks
excessive physical movement
excessive talking
being unable to wait their turn
acting without thinking
interrupting conversations
little or no sense of danger
in adults
Hard to define due to lack of research
Hyperactiveness tend to decrease in adults and inattentiveness tends to increase in adults
carelessness and lack of attention to detail
continually starting new tasks before finishing old ones
poor organisational skills
inability to focus or prioritise
continually losing or misplacing things
forgetfulness
restlessness and edginess
difficulty keeping quiet, and speaking out of turn
blurting out responses and often interrupting others
mood swings, irritability and a quick temper
inability to deal with stress
extreme impatience
taking risks in activities. For example, driving dangerously
Diagnosis & Assessment
Assessment
History
Physical & mental state examination
Rating scales
Diagnosis
DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL
DISORDER FIFTH EDITION (DSM-5)
Symptoms and/or behaviors that have persisted for more than or equal to 6 months in 2 or more settings
Type of ADHD
Impulsive/ hyperactive type: characterized by impulsive and hyperactive behaviors without inattention and distractibility
inattentive and distractible type: characterized predominately by attention and distractibility without hyperactivity
Combined type: characterized by impulsive and hyperactive behaviors as well inattention and distractibility
Pathophysiology
Structural and functional changes in the brains
Basal Ganglia
Limbic System
Frontal Cortex
Reticular Activating System
Changes in the levels of certain neurotransmitters
Low level of norepinephrine
Low level of dopamine