Attention Deficit Hyperactivity Disorder (ADHD)

Content
What ADHD Looks Like
Different Names for ADHD Through the Years
Diminished Proficiency in Four Executive Functions Due to ADHD
How ADHD affects an Individual?
How to Evaluate for ADHD after the Rule-Outs are Done
Causes and Contributing Factors of ADHD
Effective Treatment Model of ADHD in a Child

What ADHD Looks Like:
Inattention/Distractibility:
* doesn't seem to listen
* fails to finish assigned tasks
* often loses things
* can't concentrate
* easily distracted
* daydreams
* requires frequent redirection
* can be very quiet in classroom and missed
Impulsivity/Behavioral Disinhibition:
* rushing into things
* careless errors
* risk taking
* taking dares
* accidents/injuries
* impatience
* interruptions
Hyperactivity/Over-Arousal
* restlessness
* "can't sit still"
* talks excessively
* fidgeting
* "always on the go"
* easy arousal
* unnecessary bodily movement
Inattention
Impulsivity
Overactivity

Different Names for ADHD Through the Years:
* 1902 Defects in moral character
* 1934 Organically driven
* 1940 Minimal Brain Syndrome
* 1957 Hyperkinetic Impulse Disorder
* 1960 Minimal Brain Dysfunction (MBD)
* 1968 Hyperkinetic Reaction of Childhood (DSM II)
* 1980 Attention Deficit Disorder - ADD (DSM III)
o - with hyperactivity
o - without hyperactivity
o - residual type
* 1987 Attention-deficit Hyperactivity Disorder (DSM III-R)
o - Undifferentiated Attention Deficit Disorder (DSM III-R)
* 1994 Attention-Deficit/Hyperactivity Disorder (DSM IV)
o - 314.01: ADHD, Combined Type
o - 314.00: ADHD, Predominantly Inattentive type
o - 314.01: ADHD, Predominantly Hyperactive-Impulsive Type

Diminished Proficiency in Four Executive Functions Due to ADHD
1. Prolongation: Holding and evaluating events in working memory
2. Separation and regulation of affect: Splitting facts from feelings
3. Internalization of language: Reflection, self-control, will power
4. Reconstitution: Break events into parts and reassemble into new ideas
Purposes of the four executive functions:
* Self-regulation
* Organization of behaviors across time
* Directing behavior toward the future
* Maximization of future consequences
* Increased control over the environment
* Conforming the environment to self
Consequences of diminished proficiency in executive functions:
* Deficient self-regulation of behavior, mood, response
* Impaired ability to organize/plan behavior over time
* Inability to direct behavior toward the future
* Diminished social effectiveness and adaptability

How ADHD affects an Individual?
Input : Output
Visual : Cognition
Auditory : Emotion
Tactile : Behavior
Rule-Outs for the Diagnosis of ADHD
Rule-Outs Diagnosis : Evaluation by use of:
Gifted : IQ Test
Learning Disability : Academic-Perceptual Processing Tests
Neurological Conditions (Seizures, Brain Lesion or Tourette's Syndrome) : Pediatric Neurologist Evaluation: EEG, 24 hours EEG, MRI, CAT Scan
Behavioral or Emotional Problems : Psycho-Social History and Personality Testing

How to Evaluate for ADHD after the Rule-Outs are Done:
* Parent Interview
* Parent and School Behavioral Ratings
* Consistent History of ADHD like Behaviors
* Classroom Observations
* Behavioral Observations in Testing/Interviewing
* Relevant History:
o Family member(s) has ADHD-like problems
o Pregnancy and birth history
o Early infancy and developmental milestones
o Previous school and at home history

Causes and Contributing Factors of ADHD
1. Genetics--there is a strong hereditary link with ADHD-like symptoms
2. Fetal development:
* Premature babies have higher risk of ADHD like symptoms
* Trauma/infection/complications in during pregnancy can result in child being at risk for ADHD like symptoms
3. Fetal exposure to drugs and alcohol: many children who were exposed during pregnancy to drugs and/or alcohol have a greater risk for having ADHD like symptoms 4. Birth Factors which increase the risk of children having ADHD like symptoms are:
* Prolonged or induced labor
* Type of delivery can have impact if sudden, or extremely long and slow delivery
* Weight at birth if below 5 lbs. a greater risk
5. Post-birth factors:
* Cranial bleeding
* Seizures
* Concussion/coma
6. Abnormalities of brain structure
* Frontal lobe involvement
7. Lead poisoning
8. Related medical conditions that look like ADHD
* Hypothyroidism
* Seizures
* Mental retardation/autistic spectrum/Tourette's syndrome

Effective Treatment Model of ADHD in a Child
After a diagnosis has been made that a child has ADHD like symptoms then the behavioral team needs to insure that:
Encourage the Parent to be a Consistent Pathfinder Parenting Team
Home Modifications with logical and natural consequences
Creation of strong Parent-Teacher Team with home and school strong communications
504 Plan with an Individual Education Plan for Classroom Modifications
Consistency of Parent/Teacher Behavioral Team
Unconditional Love from all Adults in Child's World
Use of Medications as Last Resort