Transcript Assessment of ADHD - Tata Interactive Systems

ASSESSMENT OF ADHD
Dr. Kersi Chavda
FACT:
ADHD is a clinical diagnosis with no specific
validated biological or cognitive tests.
EVALUATION SHOULD IDEALLY INCLUDE
Interview with parents to evaluate
developmental, medical and family history, and
assess family functioning
 Interview with child to assess physical disorder,
co morbid mood disorder, tic disorder, anxiety
disorder, substance use disorder or speech or
language problems

NOTE THAT…
Patients with ADHD, either youth or adult, tend
to under report their ADHD symptoms, so
collaborative history is helpful
CHECK OUT:
Medical problems e.g. endocrinopathy,
environmental exposure
 Neurological disorders e.g. petit mal epilepsy or
complex partial seizures
 Collateral information from school, including
school rating scales
 Specific Rating scales for parents and teachers

ASSESSMENT SCALES FOR ADHD
DSM IV scales
 Connors Rating Scale –Revised
These have demonstrated high sensitivity and
specificity for differentiating between children
with ADHD and aged-matched community
controls

LAB TESTS:
Lead levels(not common)
 Thyroid function tests
 Vit B12 levels
 Vit D3 levels
 Iron deficiency
 EEG
 Neuro –imaging
 Genetic testing

SPECIALIST CONSULTATION


Us e the services of a Neuro-developmental
Paediatrician , neurologist, psychiatrist,
psychologist, Occupational Therapist
Rarely hospitalize if the patient is a danger to
himself or to another
D/D
Thyroid disorders
 Foetal -alcohol syndrome
 PANDAS
 Autism and PDD
 Conduct Disorder
 Oppositional Defiant Disorder
 Depressive disorder/Bipolar disorder
 Substance use disorder

ONCE DIAGNOSIS OCCURS….
move towards treatment
Treatment of ADHD
FACT:
The Multimodal Treatment Study for ADHD
suggested that stimulant medication is a
reasonable first-line treatment for most children
with ADHD.
However, concomitant psycho-socio-behavioural
interventions are also indicated.
NON- DRUG THERAPY
Behaviour Therapy:
As an adjunct to drug therapy
Alone as initial therapy in very young
children or those with mild symptoms or if there
is a disagreement about the diagnosis
ASPECTS OF BEHAVIOUR THERAPY
Information and the natural history of the
condition
 Learning to observe the child's appropriate and
inappropriate behaviour more carefully
 Using a home “Token economy” system
effectively…positive and negative reinforcements

ALSO
How to use “Time out” effectively
 How to manage non-compliant behaviours in
public
 Learning to avoid future behavioural
catastrophes

YOU NEED TO
take individual differences in co morbid mental
health issues and behavioural problems,
functional impairments and family issues ,into
account while designing appropriate
interventions
NOTE
There is no evidence to support the use of CBT,
Play Therapy or dietary modifications in the
treatment of ADHD in children.
However, there is evidence to support the use of
CBT with drug therapy in the treatment of
adults with ADHD.
TEACHERS ROLE
Individualize intervention plans to meet the
specific needs of the child
 Identify antecedents and consequences of their
classroom behaviours
 Clearly state class-room rules
 Provide a structured learning environment
 Review the rules every day

IMPORTANT
Give feedback to the student frequently
 Provide consistent consequences
 Provide positive feedback for good behavior and
ignore mild inappropriate ones
 Preferential seating
 Divide longer assignments into smaller discrete
pieces
 Use a token economy system

ALSO
Use “Time-out” appropriately
 Consider interventions like use of a buddy/peer
tutoring
 Use of concessions laid down by the various
Boards of education

USE OF OCCUPATIONAL THERAPY
This is known to benefit kids who have
ADHD….done on a long term basis.
 It can be used individually or in a group situation

PHARMACOLOGICAL TREATMENTS
Consider stimulants like Methylphenidate to be
the first –line drug treatment
Response rates estimated to be between 75 to
80%
OTHER MEDICATIONS
Atomoxetine
 Buproprion
 TCAs
 Clonidine
 Anti-psychotics?
 Anti-epileptics?

SPECIFIC RECOMMENDATIONS:
Explain ADHD to parents and their families
 Encourage patients to reach their individual
treatment goals
 Explain the rationale of specific behavioural
modifications
 Explain drug therapy>>>why? How long?
Dosage? Side-effects

ALSO
Read…but remember that Dr Google is not a
doctor
 Join support groups or start them in your area
 Follow-up/ monitor patients regularly

HOWEVER…
Pharmacological or psychotherapeutic treatment
of co morbid psychiatric disorders may need to be
initiated first if they are significantly
impairing…e.g. mood disorders or tic disorders
Thank you