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Dx and tx of ADD
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inappropriate inattention and impulsivity with or without hyperactivity (Merck). Heterogeneous behavioral disorder of uncertain cause Always present in Childhood, usually adolescence, and may persist into adulthood
other children the same age. In adults, the symptoms must affect the ability to function in daily life and persist from childhood. behaviors must create significant difficulty in at least two areas of life, such as home, social settings, school, or work. Symptoms must be present for at least six months.
Diagnosing
Behavioral observations- checklist
Incidence
One of the most common neurobehavioral disorders in
childhood Estimated prevalence in 3 to 5% of school age population Occurs three times more often in boys than girls
Etiology
Causes not clear, recent research looking at:
to which it is linked Neurochemical imbalances- medications that influence neurotransmitters are effective in some
Subtypes in DSMIV-TR
The DSM-IV identifies three sub-types of ADHD,
depending on the presence or absence of particular symptoms: Inattentive type, Hyperactive type, and Combined type. To be diagnosed with ADHD, individuals must have six of the nine characteristics in either or both DSM-IV categories listed below.
mistakes. Has difficulty sustaining attention. Does not appear to listen. Struggles to follow through on instructions. Has difficulty with organization. Avoids or dislikes tasks requiring sustained mental effort. Loses things. Is easily distracted. Is forgetful in daily activities.
What we see:
Frequent and severe inattention (poor sustained
attention) and impulsivity, including: oFailure to attend to details oPoor attention during play oDifficulty actively listening to instructions or conversation, o Difficult organizing tasks oAvoidance of tasks requiring sustained attention oEasily distracted
expected Frequent fidgeting Constantly on the go Difficulty playing quietly Excessive talking
Impulsivity
Inability to wait ones turn
asked
Thus:
Low frustration tolerance
Sleep disturbances Demands for attention poor self esteem At risk for injury due to risk taking and
impulsive behavior
Similar conditions
Certain conditions that could mimic ADHD or cause the
ADHD-like behaviors are: A sudden life changes (such as divorce, a death in the family, or moving) Undetected seizures Thyroid problems Sleep problems Anxiety Depression Lead toxicity
Prognosis
into adolescence and adulthood
ADD:
socially appropriate behavior ADD with impulsivity/hyperactivity: Higher incidence of personality trait and ab nitsocial personality Impulsivity, restlessness, and poor social skills continue Both: Adjust better to work than school Depression, interpersonal problems, low intelligience
Medical management
Medications psychostimulants help with overactivity,
attention span, impulsivity, self control common names are Ritalin, Concerta, Focolan, Adderall May take time to determine which one(s) work best for child (side effects) Behavioral interventions for persistent behaviors (even with medications) Counseling, cognitive behavioral therapy, behavior modification, social skills training Educational support, OT, Speech, behavior specialists
ADLs
Sensory Perceptual Skills Motor & Praxis Skills Emotional Regulation Skills Cognitive Skills Comm. & Social Skills
Habits
Cultural
Routines Roles
Personal Physical
Rituals
Seque. & Timing Required Actions Required Body Funct Required Body Structures
LEARNING DISABILITIES
Definition
A group of problems that affect a childs ability to master
school tasks, process information, and communicate effectively. Most children have average or above average intelligence Do not have deafness or blindness As defined by IDEA: Group of disorders that interfere with child's ability to learn in typical classroom Discrepancy between childs cognitive ability and their academic achievement
Incidence
Affects 4 to 5% of the school
population More boys than girls affected by ratio of 4 to 1. Girls may be less frequently diagnosed
Etiology
No single cause defined
Disorders of motor function may include: Clumsiness, poor gross and fine motor skills, dyspraxia (motor planning), problems with balance and sensorimotor problems
Educational disorders in one or more subject area. Related problems with copying from board, handwriting, organizing time and materials, understanding written and oral directions, letter reversals, cutting, coloring, drawing. Disorders of attention and concentration (ADD ADHD)
Disorders of thinking and memory: abstract reasoning, and concept formation, poor short and long term memory
including laterality, directionality as well as other Visual Perceptual problems Psychosocial problems: Social delays, tantrums, antisocial behaviors, poor self esteem (have the intellect to know they are not performing as peers, may be teased)
Reading and writing are difficult, as are grammar and reading comprehension. May also have trouble expressing themselves verbally and putting together thoughts during conversation. Dysgraphia affects a person's writing abilities. May have a variety of problems, including: handwriting, spelling, putting thoughts on paper Dyscalculia affects a person's ability to do math. Many forms and different symptoms seen. In young children, dyscalculia may affect learning to count and recognize numbers. In the older child, trouble solving basic math problems or memorizing things like multiplication tables may occur.
performance: problems with auditory perception and auditory memory, not hearing acuity. Auditory memory, Phonemic synthesis sound out words and blends Speech in noise screen out background noise Auditory sequencing of sounds, words, or numbers
psychologist, a developmental psychologist. Evaluations may also be done by an occupational therapist, or a speech and language therapist
Disabilities Education Act (IDEA), qualified children with learning disorders are entitled to receive special education services for free in public schools. A team of special educators create an individualized education program (IEP) that outlines what special services he needs to learn at school. Educators and related services personnel implement IEP.
Management (cont)
Resources are also available outside of the public school
system, including: Private schools that specialize in treating children with learning disabilities After-school programs designed for children with learning disabilities At-home tutoring and therapy services
Prognosis
Early intervention is critical
Outcomes can be good depending on how extensive the
learning problem and appropriate support for learning and psychosocial issues Life and career options can be made to capitalize on ones strengths College is not out of the questions LD is much more recognized and accepted, and resources are available even on college level
ADLs
IADLs
Work Play
OT Intervention
Sensory motor
Sensory integration
Handwriting Organizational skills Visual perceptual remediation Social skills Community and vocational skills Visual Perceptual problems
References
Case-Smith, J. and OBrien, J. Occupational Therapy for
Children, Sixth edition(2010). Maryland Heights: Mosby Elsevier. Beers, M and Berkow, R., (eds). The Merck Manual of Diagnosis and Therapy, 17th edition(1999). Whitehouse Station: Merck Research Laboratories http://children.webmd.com/detecting-learning-disabilities http://children.webmd.com/detecting-learning-disabilities http://www.chadd.org