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ADHD

Eesha Sharma, M.D.


Department of Child and Adolescent Psychiatry
NIMHANS, Bangalore
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ADHD as a chronic condition and handling the stigma
around it

Focus on ADHD in Children and how to handle /


manage the situation better

Awareness on how children can grow with this


chronic ailment with examples of adults handling it
Physical abilities
Thinking and understanding abilities
Speech & language
Social abilities
Value systems
Source: https://gym1.net/2016/12/28/motor-skill-athletic-development/
Source: https://www.autismag.org/forum/media/average-concentration-spans-for-children.206/
Attention to spoken word

Females

Males
Attention to spaces

Females

Males
Basic sensory/motor Control & Salience
BRAIN networks networks
MATURATION
90% 100%
BRAIN SIZE

Gogtay, 2004
Neuro-developmental disorders

Physical
Thinking
Speech
Social
Values
What is ADHD?

Inattention  Clinical subtypes

 Range of symptoms
Hyperactivity  Responsiveness to medication

 Co-existing conditions

Impulsivity

Thapar, 2000
All that ADHD is…

Sustained attention
Working memory
Inattention Control
Timing

Restlessness
Hyperactivity Lack of inhibition

Control
Emotionality/reactivity
Impulsivity Motivation
Reward sensitivity
Rewards
Work only if immediately given
Have to be really exciting!
Lose interest in rewards quickly
Fronto-cerebellar network Timing
Fronto-striatal network Inhibition
Reward network Motivation & salience
Executive function network Control & persistence
Attentional network Sustained attention
Dual systems/ Maturational imbalance model
“Tough” kids

Rule-governed
behavior

Social skills

Aggression
Academic &
school skills
Non-compliance

Self-management
skills

Rhode & Jenson, 2010; Gelfand & Drew, 2003


Over long-term...
Education Lower attainment; higher rates of dropout
Domain
Occupation Higher unemployment; lower occupational status; frequent
Outco job changes

Marriage Higher rates of separation, divorce

Social relations Less contact with relatives, friends

Physical health Higher rates of hospitalisation; mortality

Mental health Higher rates of psychological symptoms, alcohol and drug


abuse and psychiatric hospitalisation

Criminality Arrests, rates of driving while intoxicated

Intergenerational More children with conduct problems

Kazdin et al, 1995; Farrington et al, 1995


ADHD
with
age
A continuum of problems
Academic School
Delinquency
difficulties dropout

Frequent
‘loss of
interest’

Social
difficulties
Disruptive
behaviors

Emotional
dysregulation
Top 10 predictors of externalizing
behavior
•Parenting
•Attachment
•School climate
•Neighborhood characteristics
•Water (availability and hygiene)
•Sanitation
•Ventilation
•Toxic exposures (fuel, tobacco, traffic) n=1285 (26.5% with Ext/Int problems)
•Electromagnetic exposure Random forest
•Pesticide exposure Average accuracy ~ 75%
•Noise
Goodness of fit
Parental demands/
expectations

Child’s
characteristics &
capabilities

Chess & Thomas, 1991; Rutter, 2003


Coercive parent-child interaction
Positive behaviors ignored ---- extinguished
Negative behaviors reinforced

Stage I Poor discipline, parental


inconsistency

Stage II Coercive pattern extended to peers


& other adults

Stage III Association with deviant peers

Stage IV Chaotic adult outcomes

Patterson, 1982; Gardner, 1989


What can parents do?

● Don’t view the child as intrinsically bad


● ‘Good child with bad habits’
● Problem behaviours didn’t develop overnight
● Break coercive patterns
● Supervision and monitoring
● Manage your own mental wellness
Family systems

❖ Explicit rules, roles and routines


❖ Clear and direct communication styles
❖ Family problem solving skills
❖ Hierarchies, intergenerational boundaries
Making a child ‘listen’
● A request is not a question
● Give time (approximately 3 to 5 seconds)
● Get close to the child when giving the request
● Use the child’s name when giving a request
● Do not give repeated commands
● Look the child in the eye when you give a request
● Direct rather than indirect (i.e., a suggestion)
● Clear and specific request
● Quiet, positive voice
● “Do” requests rather than “Don’t” requests
● High probability request immediately before low probability request
● Socially reward the child for following the request
Albert Einstein