Post on 22-May-2015
description
家有過動兒
What is Attention-Deficit/ Hyperactivity
Disorder (ADHD)?
core symptoms
Inattention Hyperactivity/Impulsivity
2
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
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
DSM-5 Criteria People with ADHD show a persistent pattern of inattention and/or
hyperactivity-impulsivity that interferes with functioning or developmentSymptoms 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).
Series10%
5%
10%
15%
2003 2007 2011
2.3%
9.5%
11.0%
Prevalence
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%
Gender
1/51/11
Psychiatric Disorder?
ADHD is one of the most common
neurodevelopemental disorders of childhood.
USA CDC website
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
Toward Systems Neuroscience of ADHD: A Meta-Analysis of 55 fMRI Studies (Am J Psychiatry 2012; 169:1038–1055)
Hypoactivation in ADHD relativeto comparison subjects was observedmostly in systems involved in executivefunction (frontoparietal network) and attention(ventral attentional network).
長大會好嗎?
J Psychiatr Res. 2011
ADHD: 110 人Control 105 人
78%Persistence
Impaired function
Remitted but treated
Genetic component?
共病症
Disruptive behavior disorder
Mood disorders Anxiety disorders
tics and Tourette Syndrome Learning Disabilities
Substance abuse
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
50%有學習障礙
Mood Disorder
10-30% 小孩47% 成人
憂鬱
躁症 , 雙極症20% of individual with ADHD
Anxiety Disorder
Up to 30% 小孩25-40% 成人
對 Ritalin 治療反應較不好(30% VS 70-80%)
Disruptive Behavior Disorder
40%Conduct Disorder
25% 兒童
40-50% 青少年
20-25% 成人
Oppositional Defiant Disorder
Substance abuse
%
ControlPersistent
Management
Behavioral therapy
Medication
Headache, abd painDecreased appetite, sleep disorder
Parent
PeerTeacher
579 ADHD combined type(7-10y/o) Follow-up 14 mo Arch Gen Psy 1999
Hyperactive-impulsive symptoms
Parent-Child ArguingSocial skills
Internalizing symptoms
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
What can the physician do ?
AAP 2011 clinical practice guideline
1
4-18 y/oAcademic orBehavioralProblem
Initiate ADHD evaluation
Inattention,Hyperactivity,
Impulsivity+
SNAP IV
http://otk.idv.tw/snap/
兒童注意力量表
2To 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
Preschoolaged Children (4 –5 Years Old)
challenges in determining the presence of key symptoms
AdolescentsTry 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.
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)
3
Recognize ADHD as a
chronic condition
4
5Treatment 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
每 13 個小孩有 1 個過動行為治療和藥物相輔相成