Attention Deficit Hyperactivity Disorder

(ADHD)

Robyn SmithDepartment of PhysiotherapyUniversity Free State2012

Attention Deficit Hyperactivity Disorder, commonly referred to as ADHD

OR

often incorrectly as Attention Deficit Disorder or ADD

How common is ADHD?National Institute of Mental Health (NIMH) estimates that between 3-5% of pre-school or school aged children have ADHDe.g. Class of 35 children there will be 2 children will have ADHD

Diagnosed 3-4 times more in boys than girls

Estimated ADHD affects 4.1% adults aged 18 to 44 years

What is ADHD?

ADHD is a developmental disordermostly diagnosed during childhood,particularly once school-going (pre-school or school) age is reached

What is ADHD?

ADHD is characterised by 3 key aspects:

Inattention to the surrounding environmentHyperactivityImpulsivity

Most children living with the disorder have a combination of these symptoms

How is a diagnosis of ADHD made?A Diagnosis is made on the following basis:

Symptoms must have been present ≤ 7 years of ageSymptoms have to persist for at least 6 months Symptoms must be present in at least 2 different settings or environments e.g. home and at school Be inconsistent or abnormal for the child’s developmental level and age,Cause significant impairmentin functioning and ADL

Is ADHD related to other problems ?• ADHD often exists in conjunction with other

behavioural disorders, learning or language problems and anxiety disorders

What causes of ADHD?

80% genetic or hereditary cause

Most often runs in familiesEvidence suggests that the principle cause is genetic Type of ADHD that persists into childhood is more likely to have a strong genetic link

What causes of ADHD?20% non hereditary causes, including:

Mother who uses alcohol and tobacco during pregnancyMother exposed to abnormally high levels of lead during pregnancy (may lead foetal hypoxia)PrematurityMalnutritionDiet rich in additives and preservativesTraumatic brain injuryPost traumatic stress disorderSensory integration disorders

What does a child with ADHD look like?

Signs of inattentivenessInattentiveness to the point that it is disruptive or inappropriate for age:Often does not give close attention to details or makes careless mistakes in schoolwork.Often has trouble keeping attention on tasks or play activities. Often does not seem to listen when spoken to directly. Often does not follow instructions and fails to finish schoolwork or chores.Often has trouble organising activities. Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework). Often loses things needed for tasks andIs often easily distracted. Often forgetful in daily activities.

Signs of HyperactivityHyperactivity to an extent that is disruptive and inappropriate for age:

Often fidgets with hands or feet or squirms in seat. Often gets up from seat when remaining in seat is expected. Often runs around when and where it is not appropriate ,and constantly seems restless. Often has trouble playing or enjoying leisure activities quietly. Is often "on the go" or often acts as if "driven by a motor". Often talks excessively.

Signs of ImpulsivityImpulsivity to an extent that is disruptive and inappropriate for age:

Often blurts out answers before questions have been finished. Often has trouble waiting one's turn. Often interrupts or intrudes on others (e.g. butts into conversations or games).

Impact of ADHD on the child’s functioning

The lack of attentiveness, hyperactivity and impulsiveness significantly impairs their social and scholastic functioning.

These children also often present with:Poor self esteemSeek immediate reinforcement (sensitive to rewards)Learning difficultiesPerceptual problemsVisual and spatial orientation problemsLanguage deficits e.g. dyslexia and poor expressive language skills Physical difficulties may occur like “clumsiness”

Management of ADHD

There is no cure for ADHD but it can be treated effectively.

ADHD often causes stress and anxiety, anger and frustration within the family and the entire family needs interdisciplinary support.

Can involve multiple types of therapies overtime

Management of ADHD1. Medication:

Start between ages of 5 -7 years2 main types medication used

Ritalin = CNS stimulantsStraterra monitor growth

Anti- depressants

Medication must be taken exactly as prescribed and should not suddenly be stopped. Regular follow up by a paediatrician advised.

Management of ADHD2. Diet

Dietary adjustment helps in 5 % cases

Reduce sugar intakeAvoid colourants and preservatives in foodOmega 3 and 6 fatty acid supplementation recommended (little scientific evidence though to support this...)

Management of ADHD3. Psychological therapies

Parent- and teacher interventionsSetting limits and explaining consequences for actionsPlay therapyBehavioural and family therapies

Psychologist

Management of ADHD

4. Neurodevelopmental problems

Developmental delays need to be addressed by

physiotherapists, occupational and speech

therapists.

Low tonePoor balance

Poor coordination

(Refer to DCD/ASD for treatment principles)

References

Venter, A. 2006. Attention Deficit Hyperactivity Disorder. New directions. Department of Paediatrics and Child Health (lecture notes unpublished)

ADHD: reality not a myth. Information guide or booklet sponsored by Janssen-Cilag.

MEDIHELP Medical Scheme. 2012. Living with ADHD information guide and video.