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All About ADHD

All About ADHD. All about ADHD. Tonight’s topics: ADHD Child Assessment and Diagnosis – Janine Hubbard, PhD., R. Psych. Parenting and ADHD Lorna Berndt Piercey , M.Sc. , R. Psych. Medication Options in ADHD Kim St. John, MD . ADHD in Adults Bev McLean, M.Sc., R. Psych .

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All About ADHD

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  1. All About ADHD

  2. All about ADHD • Tonight’s topics: • ADHD Child Assessment and Diagnosis – • Janine Hubbard, PhD., R. Psych. • Parenting and ADHD • Lorna Berndt Piercey, M.Sc., R. Psych. • Medication Options in ADHD • Kim St. John, MD. • ADHD in Adults • Bev McLean, M.Sc., R. Psych. • ADHD in post secondary settings and ADHD strengths • Lisa Moores, PsyD., R. Psych. • Questions and discussion

  3. ADHD Child Assessment and Diagnosis Janine Hubbard, PhD., R. Psych.

  4. Background • Neurodevelopmental disorder • Most prevalent childhood psychiatric disorder in Canada • Occurs in approximately 5% of children (some est. as high as 12%) • Strong genetic component • Persists into adulthood

  5. Background • Problem with regulation of attention, not just inattention • Can present as over-focused (esp. when very interested) • Difficulty refocusing/transitioning from one activity to another • Attention levels may fluctuate from day to day (even for same tasks)

  6. Background • Not diagnosed prior to age 6 • Symptoms present before age 12 • Symptoms present in two or more settings • Symptoms interfere with functioning • Not otherwise explained by underlying medical or psychiatric disorder

  7. Types of ADHD (DSM-V) • Predominantly Inattentive (previously ADD) • Predominantly Hyperactive/Impulsive • Combined

  8. Inattentive Presentation • fails to give close attention to details or makes careless mistakes • has difficulty sustaining attention • does not seem to listen when spoken to directly • does not follow through on instructions and fails to finish tasks • has difficulty organizing tasks and activities • dislikes or avoids tasks that require sustained mental effort • loses things necessary for tasks or activities • is often easily distracted (either external distraction or internal thoughts) • forgetful in daily activities

  9. Hyperactive/Impulsive Presentation • fidgets, taps hands or feet, squirms in chair • leaves seat inappropriately • runs about or climbs in inappropriate situations • unable to play quietly • difficulty staying still for long periods of time (“on the go” “driven by a motor”) • talks excessively • blurts out answers before question has been completed • difficulty waiting his or her turn • interrupts or intrudes on others (conversations, belongings, activities)

  10. ADHD in Girls • Est. 3:1-2:1 ratio of males:females • Girls often diagnosed later • Symptoms often confused with anxiety and depression • Inattentive presentation more common • Highly intelligent girls less likely to be diagnosed • Symptoms of mood swings, anxiety and depression often increase in adolescence

  11. Differential Diagnosis: What Else Could It Be? • Anxiety • Depression • OCD • Learning issues • Above average/below average intelligence • Expressive/receptive language difficulties

  12. Differential Diagnosis: What Else Could It Be? • History of trauma • Family issues • Sleep issues • Vision/hearing problems • Medication side effects

  13. Psychological Assessment • Cognitive abilities • Academic achievement • Memory • Attention/concentration • Executive functioning • Behavioural/emotional functioning • Review of report cards, parent interview, developmental history

  14. Cognitive Abilities • Verbal reasoning • Visual-spatial skills • Fluid reasoning • Working memory • Processing speed

  15. Academic Achievement • Gaps/inconsistencies in achievement • Academic fluency • Sustained attention • Careless/inattentive errors • Assess for potential specific learning disorder

  16. Memory • Auditory vs visual memory skills • Short term vs long-term memory skills

  17. Attention/Concentration • Auditory vs visual attention • Brief vs sustained attention • Dual attention

  18. Executive Functioning • Inhibition • Shift • Initiation • Working memory • Planning/organizing • Organization of materials • Self-monitoring

  19. Behavioural/Emotional Functioning • Measures of home/school/self-report • General screen of behavioural/emotional functioning • Attention specific questionnaires • Age/gender normed

  20. Thank you!

  21. Parenting and ADHD Lorna Berndt Piercey, M.Sc., R. Psych.

  22. Main Features of ADHD

  23. InATTENTION • difficulty changing activity • hyperfocusing • losing things • not putting things away • homework

  24. IMPULSIVENESS • interrupting • acting “without thinking” • dangerous or destructive actions

  25. HYPERACTIVITY • fidgeting • intense reactions • always moving • difficulty being quiet when necessary

  26. FAMILY DECISION • decide on specific goals • discuss these with your child • work out a plan for each goal; your aim is to make the desired behaviour a habit • do not add more goals too quickly

  27. WHAT DOESN'T WORK • ranting • “distant” punishments • warnings about future dire consequences • getting pulled into arguments • lectures • getting “the last word”

  28. WHAT HELPS • noticing and acknowledging positive behaviour • consistent expectations • consistent consequences • solving problems together

  29. WHAT HELPS • practical solutions • noticing when your child is overtired and losing control • remembering that there is a physiological reason for your child's behaviour • parental breaks

  30. Medication Options in ADHD October 2017 APNL Kim St. John, MD.

  31. Objectives • Look at the role of medication in ADHD • Review the common medications, including side effects • Review options when first line medications don’t work

  32. Why?

  33. Medication alone is more effective than behavioural therapy • Combination therapy is more effective than behavioural therapy or medication alone in things like school performance, parent child relationships and social skills • Biggest reason behavioural therapy doesn’t work is impulsivity

  34. Options • Stimulants • others

  35. Stimulants • First line • Safe • Well tolerated • Increase arousal centrally

  36. Two groups • Methylphenidate • Ritalin IR • Ritalin SR • Biphentin • Concerta • Dextro-amphetamine • Dexedrine • Dexedrine Spansules • Adderal XR • Vyvanse

  37. Methylphenidate-based • Blocks reuptake of dopamine

  38. Dextro-amphetamine based • Blocks the reuptake of dopamine • Increases release of dopamine and noradrenaline

  39. Common Side Effects • Decreased appetite • Trouble getting to sleep • “unmask” tics • Mood symptoms • Increased anxiety • Headaches • Rebound hyperactivity • Slight BP and pulse increases

  40. Sudden death-rare

  41. How to choose? • Family history • Medical history • Most times doesn’t matter

  42. Cost Long acting are generally more expensive but covered by NLPDP, special authorization Most private insurances cover Concerta Some cover Vyvanse

  43. Long acting best • No peaks and troughs • Longer action- single dose, no medication at school • Less diversion • Biggest role for short acting is top up (end of day or to help kick in )

  44. Dextro-amphetamine related

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