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May 2010/BJL

Attention Deficit Hyperactivity Disorder (ADHD) Presented by: APS Healthcare Southwestern PA Health Care Quality Unit (HCQU). May 2010/BJL. Disclaimer.

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May 2010/BJL

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  1. Attention Deficit Hyperactivity Disorder (ADHD)Presented by: APS HealthcareSouthwestern PA Health Care Quality Unit(HCQU) May 2010/BJL

  2. Disclaimer Information or education provided by the HCQU is not intended to replace medical advice from the consumer’s personal care physician, existing facility policy or federal, state and local regulations/codes within the agency jurisdiction. The information provided is not all inclusive of the topic presented. Certificates for training hours will only be awarded to those who attend a training in its entirety. Attendees are responsible for submitting paperwork to their respective agencies.

  3. Note of Clarification While mental retardation (MR) is still recognized as a clinical diagnosis, in an effort to support the work of self-advocates, the APS SW PA HCQU will be using the terms intellectual and/or developmental disability (I/DD) to replace mental retardation (MR) when feasible.

  4. Objectives Identify the symptoms of ADHD Describe the ways that ADHD can affect people with I/DD List the treatments and interventions for ADHD

  5. What is ADHD? Attention-Deficit/Hyperactivity Disorder (ADHD) First diagnosed in infancy, childhood, or adolescence Formerly known as Attention-Deficit Disorder (ADD)

  6. ADHD – What Is It? Attention-Deficit and Disruptive Behavior Disorder Stable pattern of inattention and/or hyperactive - impulsive behavior Symptoms begin before age 7 Inattentive and/or hyperactive-impulsive behavior occurs in many settings (i.e. home & school/work) Other medical/mental health conditions do not cause symptoms

  7. ADHD – Definition Symptoms must cause significant difficulties in school/work, social, and family life Symptoms are present at least 6 months for a diagnosis

  8. The Experience of ADHD What is it like to have ADHD? “It’s like having a whirlwind in your mind. Everything is blowing around and nothing stays put.” “I have been told I hop from topic to topic like jumping from stone to stone in a creek.”

  9. Executive Functions and ADHD Problems in the use and development of executive functions Executive functions: - Abilities that allow us to fully think through a problem or situation in order to reach a conclusion or a solution

  10. Executive Functions and ADHD 6 Executive Functions Self-talk Working Memory Foresight Sense of Time Shifting from Agenda A to Agenda B Separating Emotion from Fact

  11. ADHD – Facts and Statistics 5 million U.S. children between ages 3 and 17 diagnosed with ADHD 11% of all U.S. boys 4.8% of all U.S. girls 7.65 million people with I/DD – 765,000 have ADHD (Bagner, 2003)

  12. ADHD – History First described in 1798 by Scottish physician Sir Alexander Crichton Described the ‘inattentive’ subtype of ADHD

  13. ADHD – History 1845 - Heinrich Hoffman and "The Story of Fidgety Philip" Story of a boy with characteristics similar to ADHD

  14. ADHD – Gender Differences BOYS Overactive Aggressive Disruptive Usually referred for guidance services Physically active and rowdy GIRLS Depressed Anxious Self-critical/self-blaming Often overlooked by teachers Excessive giggling, doodling, and talking at school or day program

  15. ADHD Persists Throughout Life 1/2 to 2/3 of children will have symptoms as adults 4.4% of U.S. adults have ADHD symptoms These symptoms can impact their work, family, and social relationships

  16. ADHD – Onset of Symptoms Begins between ages 3 to 6 Symptoms are not always obvious in children. Some children display ADHD symptoms before birth.

  17. Research Shows the Following: ADHD may result from genetic factors. Heritability of ADHD averages 80%. Chemical activity in the brain may explain symptoms. Combining and sustaining treatment methods is most effective.

  18. Research Shows that ADHD is NOT Caused By: Poor parenting Family problems Poor teachers/schools Too much television Food allergies or too much sugar intake

  19. Symptoms and Diagnosis of ADHD ADHD has three subtypes: Predominantly Inattentive Type Predominantly Hyperactive-Impulsive Type Combined Type

  20. Symptoms of ADHD Inattentive Type Fails to pay close attention to details; makes careless mistakes Has difficulty sustaining attention in tasks or play Often doesn’t seem to listen when spoken to directly Often doesn’t follow through on instructions; fails to finish tasks Has difficulty organizing tasks and activities

  21. Symptoms of ADHD Inattentive Type Has difficulty with tasks requiring sustained mental effort Often loses things needed for task Often easily distracted Often forgetful in daily activities

  22. Symptoms of ADHD Hyperactive/Impulsive Type Hyperactivity Fidgets with hands and/or feet or squirms in seat Difficulty remaining seated in settings where it is expected Often runs about or climbs excessively in situations where it is inappropriate; can be restlessness in adolescents/adults Often has difficulty playing quietly or engaging in quiet activities Often talks excessively

  23. Symptoms of ADHD Hyperactive/Impulsive Type Impulsivity Often calls out answers before questions are completed Often has difficulty waiting his/her turn Often interrupts or intrudes on others (i.e. ‘butts in’ on conversations)

  24. Symptoms of ADHD – Combined Type Combination of symptoms from both the inattentive and hyperactive/impulsive types

  25. ADHD and Intellectual/Developmental Disabilities Difficult to diagnose in people with I/DD Little research into I/DD and ADHD co-occurrence I/DD and ADHD can ‘look alike’ behaviorally

  26. ADHD and I/DD – Behaviors to Look For More difficulty staying focused Increased hyperactivity (especially in individuals with Down’s Syndrome) Severe inattention and impulsivity (particularly for people with Fragile X Syndrome)

  27. Treatments and Interventions Medications Psychological interventions Environmental adaptations Staff Interventions

  28. Medications Work best when used in combination with counseling Stimulants - Ritalin - Concerta - Daytrana - Adderall - Dexedrine

  29. Medications Other medications Strattera (non-stimulant) Anti-depressants (Prozac, Celexa, Zoloft, Effexor, Remeron) Intuniv Catapres & Tenex (hypertension medications)

  30. Psychological Interventions Cognitive Behavioral Therapy (CBT) Social Skills Training Family/Caregiver Education

  31. Environmental Adaptations Reduce stressors Create a schedule Stabilize the environment Provide an individual space for the person Use music to aid focus and attention Create a safe space for leisure activities

  32. Staff Interventions Communicate directly Clarify acceptable behavior Be patient Encourage the person to ‘hang in there’ Give praise whenever possible Communicate with other caregivers

  33. References American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000. Bagner, D. Nov., 2003. “ADHD and Mental Retardation.” Unpublished presentation. http://www.hp.ufl.edu/~jjohnson/ADHDMR.ppt. Retrieved 2/17/10 Bailey, E. “10 Medical Conditions That Share Symptoms with ADD/ADHD.” HealthCentral.com - Trusted, Reliable and Up To Date Health Information. N.p., n.d. Retrieved Web. 26 Feb. 2010. http://www.healthcentral.com/adhd/related-conditions-40570-5.html.

  34. References Barkley, R. “Dr. Russell A. Barkley Official Site, Authority ADHD, Attention Deficit Hyperactivity Disorder.” Dr. Russell A. Barkley Official Site, Authority ADHD, Attention Deficit Hyperactivity Disorder. N.p., n.d. Retrieved February 16, 2010. http://www.russellbarkley.org/adhd-facts.htm. “Counseling for ADHD: When Does Therapy Help? ADD ADHD Information Library.” ADD ADHD Information Library Help for Parents with ADHD Children. N.p., n.d. Retrieved February 26, 2010. http://newideas.net/adhd/adhd_counseling.

  35. References Walls, J., and Turner, A. “Attention Deficit/Hyperactivity Disorder.” Unpublished presentation. http://campus.houghton.edu/orgs/psychology/student/adhd/ADHD.ppt.Retrieved 2/15/10 “School Resources & Educational Help By Grade & Subject For Parents - FamilyEducation.com.” School Resources & Educational Help By Grade & Subject For Parents - FamilyEducation.com. N.p., n.d. Retrieved February 26, 2010. http://school.familyeducation.com. University of Wisconsin-Madison (2006, June 26). Study Reveals How ADHD Drugs Work In Brain. ScienceDaily. Retrieved March 10, 2010.

  36. References Murray, B. “Eight rules for living with someone with adhd.” Uplift Program. March 26, 2008. http://www.upliftprogram.com/tips_adhd.html Kutscher, M. “Autistic Spectrum Disorders: Sorting Out Autism, Asperger's Syndrome and Other Conditions.” PediatricNeurology.Com: Children with ADHD, ADD, autism, Aspergers, tics, seizures,and headaches.. N.p., n.d. Retrieved February 26, 2010.http://www.pediatricneurology.com/autism.htm.

  37. To register for future trainings,orfor more information on this or any other physical or behavioral health topic, please visit our website at www.hcqu.apshealthcare.com

  38. EvaluationPlease take a few moments to complete the evaluation form found in the back of your packets.Thank You!

  39. Test Review There will be a test review after all tests have beencompleted and turned in to the Instructor

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