Attention Deficit Hyperactivity Disorder (ADHD)

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Attention Deficit Hyperactivity Disorder (ADHD) by Mind Map: Attention Deficit Hyperactivity Disorder (ADHD)

1. Definition & features

1.1. DSM-V: Inattention symptoms (at least 6 symptoms); hyperactivity-impulsivity (at least 6 symptoms)

1.2. Diagnostic Criteria: -symptoms present before age 12 -clinically significant impairment in social or academic/occupational functioning -symptoms present in 2 or more settings -not due to other disorder symptoms over 6 months

1.3. Sub-types: -Inattentive ADD -Hyperactive-Impulsive -Combination of both

1.4. Comorbid condition: -Oppositional Deviant Disorder -Conduct Disorder -Anxiety Disorder -Depression -Specific Learning Difficulties Developmental Coordination Disorder

2. Developmental Course

2.1. 1. Toddler, preschool~ Motor activity 2. Primary school~ Hyperactivity & Inattention (since more homework) 3. Secondary school~Less hyperactivity & restlessness, poor planning, impulsivity 4. Adult~stable but worsening for some

3. Risk & Prognostic factors

3.1. - Temperamental (negative emotion, more novelty seeking, less behaviour inhibition) - Environmental (history of child abuse...) - Genetic & Physiological (heritability is substantial) - Course Modifiers (family interaction pattern)

4. Bronfenbrenner's Ecological Systems Theory

4.1. Risk factors (neighbourhood) vs Protective Factors (family)-> expression of behavioural problems

5. Etiological Factors

5.1. *Environmental factors are not the cause but many contribute to the expression, severity, course and comorbid conditions

5.2. *Dysfunction in prefrontal lobes -Affect inhibition and executive functions (EF)

5.2.1. Executive Functions= manage attention, emotions, pursuit of goals & more predictive of school success than IQ (Interrelated)

5.2.2. 11 Types of EF: 1. Response inhibition

5.2.2.1. Use Visual Cues

5.2.3. 2. Working Memory

5.2.3.1. Step by step procedure reminders, use a checklist

5.2.4. 3. Self-regulation of Affect

5.2.4.1. Use feelings thermometer, Facial Emotions

5.2.5. 4. Sustained Attention

5.2.5.1. Adjust tasks for shorter time frame, cut work pages, clear desk distraction, reward after task completion

5.2.6. 5. Task Initiation

5.2.6.1. Set a timer, reward after task completion, normalize the behaviour, use list or task chart

5.2.7. 6. Planning/ Prioritization

5.2.7.1. Set a reminder, To- Do List, positive reinforcement after task completion

5.2.8. 7. Organization

5.2.8.1. Use Calendar, Flow Chart, Labels, Coloured Folders

5.2.9. 8. Time Management

5.2.9.1. Set a timer and follow the checklist

5.2.10. 9. Goal-directed Persistence

5.2.10.1. Reward for showing persistence, give student a long-term responsibility such as planting a flower to develop persistence to a task

5.2.11. 10. Flexibility

5.2.11.1. Prepare students for changes in schedules or routines if possible, use visual cues when changing routines, role play for unexpected changes, disrupt the schedule in fun ways

5.2.12. 11. Metacognition

5.2.12.1. Teach problem-solving procedure, evaluative tasks,demonstrate "think aloud" during lessons, praise when student is able to check answers and correct mistakes or improve answers

5.3. *Differences in size of brain structures (prefrontal cortex, corpus callosum)

5.4. *Genes involved in dopamine regulation

5.4.1. - Neurotransmitter differences in levels of dopamine, norepinephrine, serotonin - Dopamine associated with approach & pleasure-seeking behaviours - Norepinephrine regulate emotional/behavioural regulation

5.4.1.1. Medication

5.5. *Abnormal brain activation during attention & inhibition tasks

6. Intervention Plan (with praise and attention)

6.1. Multi-modal approach= Psychosocial+ Educational Strategies+ Medical Treatment

6.1.1. Community

6.1.2. Functional Behavioural Assessment (ABC: Antecedents, Behaviour, Consequence)

6.1.2.1. Behavioural Modification

6.1.2.1.1. Positive reinforcement

6.1.2.1.2. Negative reinforcement

6.1.2.1.3. Punishment

6.1.2.1.4. Extinction( with planned ignorance)

6.1.3. Medication

6.1.4. Schools and Parents

6.2. 3-tiers: 1. Early Identification 2. Additional Support 3. Intensive Individualized Support

7. 7 Phases of Escalation Cycle 1. Calm 2. Trigger Phase 3. Agitation 4. Accerlation 5. Peak 6. De-escalation 7. Recovery

7.1. Responses in face of meltdown based on: 1. Self- awareness 2. Self- regulation 3. Motivation 4. Empathy 5. Social skills (Daniel Goleman)

7.2. Ways to de-escalate problem: 1. Be non-threatening 2. Prevent re-occurence 3. Teach anger management 4. Develop a prearranged crisis plan 5. Offer peer mediation