1. A SSESSMENT OF ADHD Dr. Kersi Chavda

2. F ACT : ADHD is a clinical diagnosis with no specific validated biological or cognitive tests.

3. E VALUATION SHOULD IDEALLY INCLUDE Interview with parents to evaluate developmental, medical and family history, and assess family functioning Interview with child to assess physical disorder, co morbid mood disorder, tic disorder, anxiety disorder, substance use disorder or speech or language problems

4. N OTE THAT … Patients with ADHD, either youth or adult, tend to under report their ADHD symptoms, so collaborative history is helpful

5. C HECK OUT : Medical problems e.g. endocrinopathy, environmental exposure Neurological disorders e.g. petit mal epilepsy or complex partial seizures Collateral information from school, including school rating scales Specific Rating scales for parents and teachers

6. A SSESSMENT SCALES FOR ADHD DSM IV scales Connors Rating Scale –Revised These have demonstrated high sensitivity and specificity for differentiating between children with ADHD and aged-matched community controls

7. L AB TESTS : Lead levels(not common) Thyroid function tests Vit B12 levels Vit D3 levels Iron deficiency EEG Neuro –imaging Genetic testing

8. S PECIALIST CONSULTATION Us e the services of a Neuro-developmental Paediatrician, neurologist, psychiatrist, psychologist, Occupational Therapist Rarely hospitalize if the patient is a danger to himself or to another

9. D/D Thyroid disorders Foetal -alcohol syndrome PANDAS Autism and PDD Conduct Disorder Oppositional Defiant Disorder Depressive disorder/Bipolar disorder Substance use disorder

10. O NCE DIAGNOSIS OCCURS …. move towards treatment

11. Treatment of ADHD

12. F ACT : The Multimodal Treatment Study for ADHD suggested that stimulant medication is a reasonable first-line treatment for most children with ADHD. However, concomitant psycho-socio-behavioural interventions are also indicated.

13. N ON - DRUG THERAPY Behaviour Therapy: As an adjunct to drug therapy Alone as initial therapy in very young children or those with mild symptoms or if there is a disagreement about the diagnosis

14. A SPECTS OF B EHAVIOUR T HERAPY Information and the natural history of the condition Learning to observe the child's appropriate and inappropriate behaviour more carefully Using a home “Token economy” system effectively…positive and negative reinforcements

15. A LSO How to use “Time out” effectively How to manage non-compliant behaviours in public Learning to avoid future behavioural catastrophes

16. Y OU NEED TO take individual differences in co morbid mental health issues and behavioural problems, functional impairments and family issues,into account while designing appropriate interventions

17. N OTE There is no evidence to support the use of CBT, Play Therapy or dietary modifications in the treatment of ADHD in children. However, there is evidence to support the use of CBT with drug therapy in the treatment of adults with ADHD.

18. T EACHERS ROLE Individualize intervention plans to meet the specific needs of the child Identify antecedents and consequences of their classroom behaviours Clearly state class-room rules Provide a structured learning environment Review the rules every day

19. I MPORTANT Give feedback to the student frequently Provide consistent consequences Provide positive feedback for good behavior and ignore mild inappropriate ones Preferential seating Divide longer assignments into smaller discrete pieces Use a token economy system

20. A LSO Use “Time-out” appropriately Consider interventions like use of a buddy/peer tutoring Use of concessions laid down by the various Boards of education

21. U SE OF O CCUPATIONAL T HERAPY This is known to benefit kids who have ADHD….done on a long term basis. It can be used individually or in a group situation

22. P HARMACOLOGICAL TREATMENTS Consider stimulants like Methylphenidate to be the first –line drug treatment Response rates estimated to be between 75 to 80%

23. O THER MEDICATIONS Atomoxetine Buproprion TCAs Clonidine Anti-psychotics? Anti-epileptics?

24. S PECIFIC RECOMMENDATIONS : Explain ADHD to parents and their families Encourage patients to reach their individual treatment goals Explain the rationale of specific behavioural modifications Explain drug therapy>>>why? How long? Dosage? Side-effects

25. A LSO Read…but remember that Dr Google is not a doctor Join support groups or start them in your area Follow-up/ monitor patients regularly

26. H OWEVER … Pharmacological or psychotherapeutic treatment of co morbid psychiatric disorders may need to be initiated first if they are significantly impairing…e.g. mood disorders or tic disorders

27. Thank you