Dr TG Magagula 13 August 2012. Behavioral disorder: noise-making, motor driven.
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Transcript of Dr TG Magagula 13 August 2012. Behavioral disorder: noise-making, motor driven.
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Dr TG Magagula13 August 2012
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Behavioral disorder: noise-making, motor driven
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Diagnosis6 or more symptoms of inattention:
careless mistakes, can’t sustain attention, doesn’t listen, can’t organize tasks, avoids schoolwork, loses things, easily distracted, forgetful.
6 or more symptoms of hyperactivity- impulsivity:Fidgeting or squirming, leaves seat, runs or
climbs excessively, cannot play quietly, on the go, talks excessively, blurts out answers, cannot await turn, often interrupts.
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DiagnosisSome symptoms have been present before
age 7.Symptoms present in at least 2 settings.Impairment of academic and / or social
functioning.Not due to another Axis 1 disorder.Code subtype: -combined type for 6/12;
predominantly: inattentive for past 6/12 or hyperactive-impulsive for past 6/12
Adults/adolescents: in partial remission
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Clinical FeaturesADHD may have its onset in infancy although
it is usually only diagnosed when the child is a toddler.
They have difficulty in waiting for anything and often start a task in a rush, but they have difficulty in finishing it.
Their mood is often irritable.
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Clinical Features Concomitant (co-morbid) emotional-
behavioral difficulties are common.About 75% of children show aggressive and
defiant behavior fairly often.School difficulties (emotional and scholastic)
are common.
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EtiologyNo single factor is known to cause ADHD:Genetic factors:
Greater concordance in monozygotic twins.Siblings have twice the risk to develop ADHD.Biological parents have higher risk for ADHD.
Developmental factors:More soft neurological deficits Brain insults: prematurity, toxins: smoking and
drinking first trimester
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Co-morbidity/differential diagnosesTemperament & visual-motor-perceptual
impairments in ADHDAnxiety/depressive disordersMania bipolar I disorder wax & waneConduct disorder; ODDLearning disorders, epilepsyMental retardation(check family history)
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Course and PrognosisThe course of ADHD is very variable.
Symptoms may continue into adulthood.Symptoms may fully remit.Hyperactivity may disappear while attention
problems persist.Persistence is predicted by:
Family history, negative life events, punitive, harsh parenting, co morbidity.
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Treatment: Bio psychosocial (MDT)Comprehensive treatment program indicatedNot all children need medsDecision to use meds based on thorough
assessment of severity, impact and developmental appropriateness of symptoms
Stimulants: Methylphenidate RitalinNon-stimulants include: Atomoxetine-
Strattera, Modafinil-Provigil
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Cognitive-behavioral approach:
Train skills: self-instruction, -evaluation,-monitoring, anger management, social behavior. Problem solving skills
Evaluation and treatment of co morbid psychiatric disorders; child and parent(s)
Inform child about purpose of medsTalk about “I am crazy” Family therapy
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Social interventionSocial skills groups.Training, assessment and treatment of parents.
Expectations and behavioral programs.Parents and teachers work together to structure
environment with set of expectations and rewards.
Behavioral interventions at home & school (star chart)
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ConclusionConcerns:
Inappropriate dx -/under dx of ADHD & prescription of ADHD medication.
“Best researched disorder in medicine”Multiple agents and therapies are
necessary to treat ADHD and co-morbidity; prevent disability.