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