ADHD

Attention-Deficit/Hyperactivity
Attention-Deficit/Hyperactivity Disorder
Disorder

Cerebral Palsy
(Athetoid
Athetoid Hemiplegic)
Hemiplegic

DORADO . GALVEZ . RIVERA . TRINIDAD

ADHD
Athetoid Hemiplegic
 ADHD
Attention-Deficit/Hyperactivity Disorder

● is a behavioural disorder that includes symptoms such as

inattentiveness, hyperactivity, and impulsiveness

● is a brain disorder marked by an ongoing pattern of

inattention and/or hyperactivity-impulsivity that
interferes with functioning or development
Symptoms
INATTENTION HYPERACTIVITY IMPULSIVITY

● disorganization ● fidgets and ● impatience

● lack of focus squirms when ● has a hard time
● difficulty paying seated waiting to talk or
attention to ● gets up frequently react
details to walk or run ● blurts out
● has trouble around answers before
staying on topic ● has trouble someone finishes
while talking playing quietly or asking them a
doing quiet question
hobbies
 Epidemiology
Epidemiologic studies:
5% of youth including children and adolescents 2.5% of
adults.
In parents and siblings of children with ADHD
Rate : 2 to 8 times greater than in the general population.

More prevalent in boys than in girls, with the ratio ranging

from 2: 1 to as high as 9: 1
Epidemiology
Higher risk :
● First-degree biological relatives
● Siblings of children with ADHD

Symptoms :
often present by age 3 years, but unless they are
very severe.
 Etiology ADHD largely genetic - approximately 75%
No evidence of gross structural damage in the CNS

Contributory factors for ADHD

● Prenatal toxic exposures ● Food additives
● Prematurity ● Colorings
● prenatal mechanical insult to the ● Preservatives
fetal nervous system ● Sugar -contribute to the causes
of hyperactive behavior
Genetic Factors
Increased concordance in monozygotic compared to
dizygotic twins

Increased risk of 2 to 8 times for siblings as well as parents

of an ADHD child compared to the general population.

Clinically, one sibling may have predominantly

impulsivity/hyperactivity symptoms and others may have
predominantly inattentive symptoms.
 Genetic Factors
Several hypotheses of the mode of transmission of ADHD such as :
● Sex-linked hypothesis, which would explain the significantly
increased rates of ADHD in males.
● Model of interaction of multiple genes that produces the various
symptoms of ADHD.
Continued investigation is necessary to clarify the complex relationships
between multiple interactive genes and the emergence of ADHD.
Neurochemical Factors
● Dopamine
● Prefrontal cortex - role in attention and
regulation of impulse control.
Neurophysiological Factors
Further studies of youth with ADHD have provided data showing
elevated beta activity in their electroencephalography (EEG) studies.
● Clarke and colleagues found that those ADHD children with
combined type of ADHD were the ones who showed significantly
elevated beta activity on EEG, and these youth also tend to show
increased mood lability and temper tantrums.
 Neuroanatomical Aspects
● Superior and temporal cortices with focusing attention
● External parietal and corpus striatal regions with motor executive functions
● Hippocampus with encoding of memory traces
● Prefrontal cortex with shifting from one stimulus to another.
● Brainstem - reticular thalamic nuclei function, is involved in sustained attention.
● MRI ,PET, SPECT suggests that populations of children with ADHD show evidence
of both decreased volume and decreased activity in prefrontal regions, anterior
cingulate, globus pallidus, caudate, thalamus, and cerebellum.
 Developmental Factors
Higher rates of ADHD are present in :
● children who were born prematurely
● whose mothers were observed to have maternal infection
during pregnancy.

Perinatal insult to the brain during early infancy caused by

infection, inflammation, and trauma may, in some cases, be
contributing factors in the emergence of ADHD symptoms.
 Developmental Factors
Exhibit nonfocal (soft) neurological signs at higher rates
than those in the general population.
According to reports :
● September is a peak month for births of children with
ADHD with and without comorbid learning disorders.
● The implication is that prenatal exposure to winter
infections during the first trimester
 Diagnosis
The principal signs of inattention, impulsivity, and hyperactivity :
basis of a detailed history of a child's early developmental
patterns along with direct observation of the child, especially
in situations that require sustained attention.

The diagnosis of ADHD requires persistent, impairing symptoms

of either hyperactivity/impulsivity or inattention in at least two
different settings.
 Diagnosis
Most children with ADHD have symptoms in school and at home.
● In school, children with ADHD often exhibit difficulties
following instructions and require increased individualized
attention from teachers.
● At home, children with ADHD frequently have difficulty
complying with their parents' directions and may need to be
asked multiple times to complete relatively simple tasks.
 Diagnosis
● Children with ADHD typically act impulsively, are
emotionally labile, explosive, lack focus, and are
irritable.
● Children for whom hyperactivity is a
predominant feature are more likely to be
referred for treatment earlier than are children
whose primarily symptoms are attention deficit.
Diagnosis
● Children with the combined inattentive and
hyperactive-impulsive symptoms of ADHD, or
predominantly hyperactive-impulsive
symptoms of ADHD, are more apt to have a
stable diagnosis over time and to exhibit
comorbid conduct disorder than those children
with inattentive ADHD.
Diagnosis
● Specific learning disorders in the areas of
reading, arithmetic, language, and writing occur
frequently in association with ADHD. Global
developmental assessment must be considered
to rule out other sources of inattention.
 Diagnosis
A child with ADHD may exhibit :
● distractibility and perseveration
● signs of visual-perceptual, auditory-perceptual, or
language-based learning disorders.

A neurological examination may reveal visual, motor, perceptual,

or auditory discriminatory immaturity or impairments without
overt signs of visual or auditory disorders.
 Diagnosis
Children with ADHD often have problems with
● motor coordination
● difficulty copying age-appropriate figures
● rapid alternating movements
● right-left discrimination
● Ambidexterity
● reflex asymmetries
● a variety of subtle non focal neurological signs (soft signs).
Diagnosis

Clinicians should obtain a

Neurological consultation and an
EEG to rule out seizure disorders.
 Role of Occupational Therapist

● Examine impact of disease or disorder to client’s quality of life

● Focus on client’s participation in occupational performance (the
ability to do the activity without any delays or distractions)
● Control their “energy” levels, hyperactivity
● provide practical solutions to occupations
● Inform family members of the changes and improvements in the
client’s therapy
 Role of Occupational Therapist

● Able to provide therapy programmes that will address the

sensory processing difficulties and help the client to attend
and learn by adapting to the environment and activities
● Occupational therapists may provide the child with tools and
coping techniques to use within school, home, and other
social environments
Cerebral Palsy
 Cerebral Palsy
(Athetoid Hemiplegic)

● a neurological disorder caused by a non-progressive brain injury or

malformation that occurs while the child’s brain is under development

● affects body movement, muscle control, muscle coordination, muscle tone,

reflex, posture and balance; it can also impact fine motor skills, gross motor
skills and oral motor functioning

● Athetosis: characterized by slow, involuntary, convoluted, writhing

movements of the fingers, hands, toes, and feet
 Incidence of cerebral palsy is
2-3 per 1000
Basal Ganglia
live births

10-20%
10-20% Has anatomical
classifications
Of cases are
athetoid
 Risk Factors

Prenatal Postnatal
● Gestational age ● Severe jaundice
● Low birth weight ● Bacterial
● Multiple birth meningitis
● Prolonged labor ● Viral encephalitis
● Falls
 Precautions

● Patients with cerebral palsy

have an increased risk for
fractures
● Seizures are common in
children with cerebral palsy
 Problems

● Gross motor delay

● Decreased functional capacity/impaired ability to perform ADLs
● Musculoskeletal deformities
● Decreased strength, muscle imbalances, and endurance
● Muscle tone abnormalities and abnormal postural tone
● Decreased coordination and balance
● Poor alignment in wheelchair (if applicable)
 Symptoms
● involuntary movement patterns
● tremors
● postural instability
● unsteadiness
● abrupt movements
● drooling
● difficulty holding head up
 Role of Occupational Therapist

● examine impact of disease or disorder to client’s quality of life

● inform family members of the changes and improvements in the client’s therapy
● attain gross motor milestones
● improve gait pattern with increased independence
● appropriate use of adaptive equipment
● increase independence with ADLs and leisure activities
● restore or maintain ROM
 Role of Occupational Therapist

● improve strength, reduced/prevention of atrophy

● improve endurance
● improve postural alignment, improved alignment in wheelchair
● improve coordination and balance
● increase awareness of sensory limitations/pressure-relieving strategies
● increase daily physical activity
● increase independence with orthotic management