Evidence Based Psychosocial Treatment for ADHD in Children

G.Aasritha WilliamPharm-D

ADHD(Attention Deficit Hyperactivity Disorder)• “Attention Deficit Hyperactivity Disorder(ADHD) is a

chronic condition that affects millions of children and often persists into adulthood.”

• Children with ADHD are often hyperactive (overactive) and have difficulty paying attention and staying focused on tasks.

• They may interrupt other people's conversations or be impulsive and impatient.

The Changing Face of ADHD CHILDHOOD

ADULTHOOD

Hyperactivity May Become Restlessness

Physical Impulsivity

May Become Verbal

Impulsivity

Inattention Often Remains Inattention

PATHOPHYSIOLOGY

-Brain studies on individuals with ADHD suggest a defect in the dopamine receptor D4 (DRD4) receptor gene and overexpression of dopamine transporter-1 (DAT1)

-The DRD4 receptor uses DA and NE to modulate attention and responses to one's environment.

The DAT1 or dopamine transporter protein takes DA/NE into the presynaptic nerve terminal so it may not have sufficient interaction with the postsynaptic receptor.

The neurotransmitters dopamine (DA) and norepinephrine (NE) are implicated in the pathophysiology of ADHD.

STATISTICS IN INDIA IN 2013

STUDY CONDUCTED

RESULTS

REFERENCE:Venkata JA, Panicker AS. Prevalence of attention deficit hyperactivity disorder in primary school children . Indian J Psychiatry 2013;55:338-42

PHARMACOLOGICAL TREATMENT

STIMULANTS• methylpheni

date hydrochloride

• dextroamphetamine sulfate

• dextroamphetamine/amphetamine formulation

• methylphenidate

NON- STIMULANTatomoxetine

ANTI DEPRESSANTS• buproprion

hydrochloride

• imipramine

ANTI HYPERTENSIVES• clonidine

hydrochloride

• guanfacine

What works for ADHD?• All of the evidence-based practice elements for use

in ADHD have their basis in Clinical Behavior Therapy (Psychosocial Therapy)

REFERENCE:From the National Institute of Mental Health and Project # U45 MC00174 from the Office of Child Health Bureau, Health Resources and Services Administration, Department of Health and Human Services

What doesn’t work for ADHD?• Treatments with little or no evidence of

effectiveness include– Special elimination diets– Vitamins or other health food remedies– Psychoanalysis– Biofeedback– Play therapy– Sensory integration training– Social skills training– Self-control training

Clinical Behavior Therapy: ‘Theory’

Proposed Mechanism: Individuals with ADHD have difficulty understanding the consequences of their actions.

Approach:Application of principles of social learning theory to modify children’s behavior by training parents and teachers to manipulate environmental antecedents, consequences and contingencies.

ABC model( Antecedent Behavior Consequence )

Contingencies

An example: The ABC Model

The ABC Model

ContingenciesTeacher makes eye contact with student, says, “Take out your math books.”

Specific interventions to help the student with ADHD

• Psycho-education with parent• Parent praise• Commands/limit setting• Response cost• Parent monitoring• Time out• Ignoring

Does acupuncture have a positive effect on school success in children?• OBJECTIVE: • To evaluate school success in pediatric patients

undergoing acupuncture treatment for various indications including ADHD.

• CONCLUSION: • Acupuncture contributed to the academic success

of the children who underwent treatment for their primary symptoms.

Reference:Tas D, Acar HVJ; Tradit Chin Med. 2014 Aug;34(4):450-4.

A review of ADHD in girls:

• OBJECTIVE: To describe the clinical presentation of attention

deficit/hyperactivity disorder (ADHD) in girls and factors influencing proper diagnosis and treatment.• RESULTS: The ADHD prevalence rates are higher among boys than girls. A low

index of clinical suspicion exists for girls; their presentation is considered "subthreshold" because inattentiveness is more prominent than hyperactivity/impulsivity. Females with ADHD may develop better coping strategies than males to mask their symptoms.

REFERENCE:Venkata JA, Panicker AS. Prevalence of attention deficit hyperactivity disorder in primary school children . Indian J Psychiatry 2013;55:338-42

“Never give up on someone with a mental illness. When "I" is replaced by "We", illness becomes wellness.”

THANK YOU

G.Aasritha William