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adHD powerpoint

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some information of attention deficit/hyperactivity disorder

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adHD powerpoint

  1. 1. 家有過動兒
  2. 2. What is Attention- Deficit/ Hyperactivity Disorder (ADHD)?
  3. 3. core symptoms Inattention Hyperactivity/ Impulsivity 2
  4. 4. Inattention Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities. Often has trouble holding attention on tasks or play activities. Often does not seem to listen when spoken to directly. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked). Often has trouble organizing tasks and activities. Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework). Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones). Is often easily distracted Is often forgetful in daily activities ≧6 symptoms of inattention for children≦16y/o, or ≧ 5 symptoms for adolescents > 17y/o and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level
  5. 5. Hyperactivity/ Impulsivity Often fidgets with or taps hands or feet, or squirms in seat. Often leaves seat in situations when remaining seated is expected. Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless). Often unable to play or take part in leisure activities quietly. Is often "on the go" acting as if "driven by a motor". Often talks excessively. Often blurts out an answer before a question has been completed. Often has trouble waiting his/her turn. Often interrupts or intrudes on others (e.g., butts into conversations or games) ≧ 6 symptoms for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level
  6. 6. DSM-5 Criteria People with ADHD show a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development Symptoms of Inattention Symptoms of Hyperactivity and Impulsivity In addition, the following conditions must be met: •Several inattentive or hyperactive-impulsive symptoms were present before age 12 years. •Several symptoms are present in two or more setting, (e.g., at home, school or work; with friends or relatives; in other activities). •There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning. •The symptoms do not happen only during the course of schizophrenia or another psychotic disorder. The symptoms are not better explained by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).
  7. 7. 0% 5% 10% 15% 2003 2007 2011 2.3% 9.5% 11.0% Prevalence
  8. 8. 國小 9.9% 1993 小一小二 6.3% 2003 7-12y/o 8.4% 2002 1070國一生 2005 7.5%
  9. 9. Gender 1/5 1/11
  10. 10. Psychiatric Disorder?
  11. 11. ADHD is one of the most common neurodevelopemental disorders of childhood. USA CDC website
  12. 12. The age of attaining peak cortical thickness in children with ADHD compared with typically developing children. Shaw P et al. PNAS 2007;104:19649-19654 Delay cortical maturation
  13. 13. Toward Systems Neuroscience of ADHD: A Meta- Analysis of 55 fMRI Studies (Am J Psychiatry 2012; 169:1038–1055)
  14. 14. Hypoactivation in ADHD relative to comparison subjects was observed mostly in systems involved in executive function (frontoparietal network) and attention (ventral attentional network).
  15. 15. 長大會好嗎?
  16. 16. J Psychiatr Res. 2011 Predictors of Persistent ADHD: An 11-year Follow-up Study Joseph Biedermana,*, Carter R. Pettya, Allison Clarkea, Alexandra Lomedicoa, and Stephen V. Faraoneb a Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School b Departments of Psychiatry and Neuroscience & Physiology, SUNY Upstate Medical University Abstract Objective—Despite the existence of several follow-up studies of children with ADHD followed up into adulthood, there is limited information on whether patterns of persistence and remission in ADHD can be predicted over the long-term. The main aim of this study was to evaluate predictors of persistence of ADHD in a large sample of boys with and without ADHD followed prospectively for 11 years into young adulthood. Method—Subjects were Caucasian, non-Hispanic boys with (N=110) and without (N=105) ADHD who were 6 to 17 years old at the baseline assessment (mean age 11 years) and 15 to 31 years old at the follow-up assessment (mean age 22 years). Subjects were comprehensively and blindly assessed with structured diagnostic interviews and assessments of cognitive, social, school, and family functioning. Results—At the 11-year follow-up, 78% of children with ADHD continued to have a full (35%) or a partial persistence (subsyndromal (22%), impaired functioning (15%), or remitted but treated (6%)). Predictors of persistence were severe impairment of ADHD, psychiatric comorbidity, and exposure to maternal psychopathology at baseline. Conclusions—These findings prospectively confirm that persistence of ADHD over the long term is predictable from psychosocial adversity and psychiatric comorbidity ascertained 11 years earlier. Keywords ADHD; persistence; predictors; longitudinal; young adult Corresponding Author: Joseph Biederman, M.D. Massachusetts General Hospital, Pediatric Psychopharmacology Unit, 55 Fruit Street, YAW 6A-6900, Boston, MA 02114; phone: 617-726-1731; fax: 617-724-3742; jbiederman@partners.org. Conflicts of interest: Dr. Joseph Biederman is currently receiving research support from the following sources: Alza, AstraZeneca, Bristol Myers Squibb, Eli Lilly and Co., Janssen Pharmaceuticals Inc., McNeil, Merck, Organon, Otsuka, Shire, NIMH, and NICHD. In 2009, Dr. Joseph Biederman received a speaker’s fee from the following sources: Fundacion Areces, Medice Pharmaceuticals, and the Spanish Child Psychiatry Association. In previous years, Dr. Joseph Biederman received research support, consultation fees, or speaker’s fees for/from the following additional sources: Abbott, AstraZeneca, Celltech, Cephalon, Eli Lilly and Co., Esai, Forest, Glaxo, Gliatech, Janssen, McNeil, NARSAD, NIDA, New River, Novartis, Noven, Neurosearch, Pfizer, Pharmacia, The Prechter Foundation, Shire, The Stanley Foundation, UCB Pharma, Inc. and Wyeth. -PAAuthorManuscriptNIH-PAAuthorManuscriptNIH-PAAuthorManuscrip ADHD: 110人 Control 105人 78% Persistence Impaired function Remitted but treated
  17. 17. Genetic component?
  18. 18. 共病症
  19. 19. Disruptive behavior disorder Mood disorders Anxiety disorders tics and Tourette Syndrome Learning Disabilities Substance abuse
  20. 20. Tics, Tourette syndrome 7% 過動症兒童 有TICS或妥瑞症 60%妥瑞症兒童 有過動症
  21. 21. 50% 有學習障礙
  22. 22. Mood Disorder 10-30% 小孩 47% 成人 憂鬱 躁症, 雙極症 20% of individual with ADHD
  23. 23. Anxiety Disorder Up to 30% 小孩 25-40% 成人 對Ritalin治療反應較不好 (30% VS 70-80%)
  24. 24. Disruptive Behavior Disorder 40% Conduct Disorder 25%兒童 40-50% 青少年 20-25% 成人 Oppositional Defiant Disorder
  25. 25. Substance abuse
  26. 26. % Control Persistent
  27. 27. Management Behavioral therapy Medication
  28. 28. Headache, abd pain Decreased appetite, sleep disorder
  29. 29. Parent Peer Teacher
  30. 30. 579 ADHD combined type(7-10y/o) Follow-up 14 mo Arch Gen Psy 1999 Hyperactive-impulsive symptoms Parent-Child Arguing Social skills Internalizing symptoms
  31. 31. Combined therapy Improvements in academic performance Reductions in conduct problems Higher levels of parental satisfaction Lower doses of stimulant medication Superior for treating children of low socioeconomic status Superior for treating children with coexisting anxiety
  32. 32. What can the physician do ? AAP 2011 clinical practice guideline
  33. 33. 4-18 y/o Academic or Behavioral Problem Initiate ADHD evaluation Inattention, Hyperactivity, Impulsivity +
  34. 34. SNAP IV http://otk.idv.tw/snap/ 兒童注意力量表
  35. 35. To make a diagnosis of ADHD, Meet DSM- V criteria Obtain report from parents, guardian, teachers, and other school and mental health clinicians Any alternative cause
  36. 36. Preschoolaged Children (4 –5 Years Old) challenges in determining the presence of key symptoms
  37. 37. Adolescents Try to obtain (with agreement from the adolescent) information from at least 2 teachers as well as information from other sources such as coaches, school guidance counselors, or leaders of community activities in which the adolescent participates Establish the younger manifestations of the condition that were missed Consider strongly substance use, depression, and anxiety as alternative or co-occurring diagnoses.
  38. 38. Assess for other conditions that might coexist with ADHD, including Emotional or behavioral condition (eg, anxiety, depressive, oppositional defiant, and conduct disorders), Developmental conditions (eg, learning and language disorders or other neurodevelopmental disorders) Physical conditions (eg, tics, sleep apnea)
  39. 39. Recognize ADHD as a chronic condition
  40. 40. Treatment vary depending on the patient’s age. Preschoolaged children (4–5 y/o) Elementary school-aged children (6–11 y/o) Adolescents (12–18 y/o) Medication Behavior therapy Medication Medication Behavior therapy Behavior therapy
  41. 41. 每13個小孩有1個過動 行為治療和藥物相輔相成

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