Outline for Adhd

I. What is ADHD? Attention Deficit Hyperactivity Disorder- a common behavior disorder that affects one in 15-20 school-age children. Boys are three times more likely to be diagnosed with it than girls, but there is no clear reason yet why more boys than girls are diagnosed with it. It is broken down into three subtypes: an inattentive type, with signs that include: * inability to pay attention to details or a tendency to make careless errors in schoolwork or other activities * difficulty with sustained attention in tasks or play activities * apparent listening problems * difficulty following instructions * problems with organization avoidance or dislike of tasks that require mental effort * tendency to lose things like toys, notebooks, or homework * distractibility * forgetfulness in daily activities 2. a hyperactive-impulsive type, with signs that include: * fidgeting or squirming * difficulty remaining seated * excessive running or climbing * difficulty playing quietly * always see ming to be â€Å"on the go† * excessive talking * blurting out answers before hearing the full question * difficulty waiting for a turn or in line * problems with interrupting or intruding 3. a combined type, which involves a combination of the other two types and is the most common A. Symptoms: impulsive, hyperactive, short attention span, trouble focusing, symptoms are present over a long period of time and occur in different settings, problems finishing tasks, disorganized, trouble following directions, easily distracted, appear forgetful or careless and frequently misplace things. 1. Explain similarities/differences of ADD and ADHD: Similarities: attention span is short, trouble controlling their behavior without medication and behavioral therapy, appear bored. Differences: ADD- attention deficit without hyperactivity and impulsiveness. ADHD- includes hyperactivity and impulsiveness. . ex of characteristics in boys: hyperactive/impulsive behavior, rough behavior b. ex of characteristics in girls: inattentive, forgetful, hyper-talkative, emotional hyper-reactive c. why it is harder to spot ADD/ADHD in girls than boys: girls are harder to spot because the criteria for spotting ADHD includes external behavioral characteristics such as aggression, defiance, and other behavioral management problems, which are more common in boys than in girls. Girls with ADHD tend to be shy, socially isolate themselves, driven or anxious, or over-focused on their studies B. How is ADHD diagnosed? There is no test that can determine whether a child has ADHD or not, just a complete evaluation. A primary care physician or the family pediatrician usually prescribes medication in the lowest dose form and does medication checks every month to see if the current dose is helping or if an increase is needed. Most of the time if there is no change at the current dose being taken, the physician increases the dose each month until adverse side effects start to be seen in the child, than a decrease in dosage happens until changes for the benefit of the child are noticed by the parent and the teachers. If there is any doubt a referral to a child psychologist or psychiatrist may be needed for further evaluation. To be considered for a diagnosis of ADHD: * a child must display behaviors from one of the three subtypes before age 7 * these behaviors must be more severe than in other kids the same age * the behaviors must last for at least 6 months * the behaviors must occur in and negatively affect at least two areas of a child's life (such as school, home, day-care settings, or friendships). The physician does a complete physical exam to rule out any other medical problems. 1. Adult Observations: Parents are asked to fill out a behavioral evaluation form that contains different behaviors in different settings and the strengths and weaknesses of their child. If there is a day-care provider, teacher, or any other family member or friend who spends time with the child evaluations are sent to them. The physician looks over all the completed evaluation, and then talks it over with an approved child psychologist with the permission of the parent, and then the physician, psychologist, parent and child all come together and talk about possible treatment options. a. Teachers – even HS teachers need to be aware of it nd/or learn how to spot it in high-schoolers and even other ages of children. ADHD can go undiagnosed for years. Some kids outgrow it others struggle with it even into high-school and through adulthood. b. Medical Examination II. What causes ADHD? It has biological origins that aren’t quite understood. There isn’t a single cause but researches are looking at a combination of factors such as genetics, environmental, chemical imbalances in the brain. II. How is ADHD treated? Can’t be cured but can be successfully managed. III. Stimulants are the best-known treatments — they've been used for more than 50 years in the treatment of ADHD. Some require several doses per day, each lasting about 4 hours; some last up to 12 hours. Possible side effects include decreased appetite, stomachache, irritability, and insomnia. There's currently no evidence of long-term side effects. IV. Nonstimulants were approved for treating ADHD in 2003. These appear to have fewer side effects than stimulants and can last up to 24 hours. V. Antidepressants are sometimes a treatment option; however, in 2004 the U. S. Food and Drug Administration (FDA) issued a warning that these drugs may lead to a rare increased risk of suicide in children and teens. If an antidepressant is recommended for your child, be sure to discuss these risks with your doctor. Medications can affect kids differently, and a child may respond well to one but not another. When determining the correct treatment, the doctor might try various medications in various doses, especially if your child is being treated for ADHD along with another disorder. A. Medication 1. Medication can be very beneficial a. All kids should have the option of being treated because it can significantly help their ability to focus/concentrate and reach their full potential B. Types of Medication 1. Stimulants a. benefits b. negative aspects . Non Stim/Herbal Remedies a. benefits b. negative aspects 3. Behavioral Therapy: Behavioral Therapy Research has shown that medications used to help curb impulsive behavior and attention difficulties are more effective when combined with behavioral therapy. Behavioral therapy attempts to change behavior patterns by: * reorganizing a child's home and school environment * giving clear directions and commands * setting up a system of consistent rewards for appropriate behaviors and negative consequences for inappropriate ones Here are examples of behavioral strategies that may help a child with ADHD: * Create a routine. Try to follow the same schedule every day, from wake-up time to bedtime. Post the schedule in a prominent place, so your child can see what's expected throughout the day and when it's time for homework, play, and chores. * Get organized. Put schoolbags, clothing, and toys in the same place every day so your child will be less likely to lose them. * Avoid distractions. Turn off the TV, radio, and computer games, especially when your child is doing homework. * Limit choices. Offer a choice between two things (this outfit, meal, toy, etc. , or that one) so that your child isn't overwhelmed and overstimulated. Change your interactions with your child. Instead of long-winded explanations and cajoling, use clear, brief directions to remind your child of responsibilities. * Use goals and rewards. Use a chart to list goals and track positive behaviors, then reward your child's efforts. Be sure the goals are realistic (think baby steps rather than overnight success). * Discipline effectively. Instead of yelling or spanking, use timeouts or removal of privileges as consequences for inappropriate behavior. Younger kids may simply need to be distracted or ignored until they display better behavior. * Help your child discover a talent. All kids need to experience success to feel good about themselves. Finding out what your child does well — whether it's sports, art, or music — can boost social skills and self-esteem. a. benefits b. negative aspects Alternative Treatments Currently, the only ADHD therapies that have been proven effective in scientific studies are medications and behavioral therapy. But your doctor may recommend additional treatments and interventions depending on your child's symptoms and needs. Some kids with ADHD, for example, may also need special educational interventions such as tutoring, occupational therapy, etc. Every child's needs are different. A number of other alternative therapies are promoted and tried by parents including: megavitamins, body treatments, diet manipulation, allergy treatment, chiropractic treatment, attention training, visual training, and traditional one-on-one â€Å"talking† psychotherapy. However, scientific research has not found them to be effective, and most have not been studied carefully, if at all. Parents should always be wary of any therapy that promises an ADHD â€Å"cure. † If you're interested in trying something new, speak with your doctor first. Parent Training Parenting a child with ADHD often brings special challenges. Kids with ADHD may not respond well to typical parenting practices. Also, because ADHD tends to run in families, parents may also have some problems with organization and consistency themselves and need active coaching to help learn these skills. Experts recommend parent education and support groups to help family members accept the diagnosis and to teach them how to help kids organize their environment, develop problem-solving skills, and cope with frustrations. Training can also teach parents to respond appropriately to a child's most trying behaviors with calm disciplining techniques. Individual or family counseling can also be helpful. ADHD in the Classroom As your child's most important advocate, you should become familiar with your child's medical, legal, and educational rights. Kids with ADHD are eligible for special services or accommodations at school under the Individuals with Disabilities in Education Act (IDEA) and an anti-discrimination law known as Section 504. Keep in touch with teachers and school officials to monitor your child's progress. In addition to using routines and a clear system of rewards, here are some other tips to share with teachers for classroom success: * Reduce seating distractions. Lessening distractions might be as simple as seating your child near the teacher instead of near the window. * Use a homework folder for parent-teacher communications. The teacher can include assignments and progress notes, and you can check to make sure all work is completed on time. * Break down assignments. Keep instructions clear and brief, breaking down larger tasks into smaller, more manageable pieces. * Give positive reinforcement. Always be on the lookout for positive behaviors. Ask the teacher to offer praise when your child stays seated, doesn't call out, or waits his or her turn instead of criticizing when he or she doesn't. Teach good study skills. Underlining, note taking, and reading out loud can help your child stay focused and retain information. * Supervise. Check that your child goes and comes from school with the correct books and materials. Sometimes kids are paired with a buddy to can help them stay on track. * Be sensitive to self-esteem issues. Ask the teacher to provide feedback to your child in private, and avoid asking your child to perform a task in public that might be too difficult. * Involve the school counselor or psychologist. He or she can help design behavioral programs to address specific problems in the classroom. Helping Your Child You're a stronger advocate for your child when you foster good partnerships with everyone involved in your child's treatment — that includes teachers, doctors, therapists, and even other family members. Take advantage of all the support and education that's available, and you'll help your child navigate toward success. Reviewed by: Richard S. Kingsley, MD Date reviewed: September 2008 Originally reviewed by: W. Douglas Tynan, PhD Back