Communication Skills: Explaining Attention Deficit Hyperactivity Disorder (ADHD)
Example OSCE station: you are a junior doctor on placement in a Child and Adolescent Mental Health Services (CAMHS) clinic. You have been asked to see Mrs. Jones, who is concerned about her hyperactive son, Connor. Take a brief history focusing on attention deficit hyperactivity disorder, and then outline the treatment options and respond to her concerns.
- Wash hands
- Introduce yourself
- Establish mother's agenda for the consultation
- Establish own agenda for the consultation
- Remind her that she can ask questions throughout the consultation
Important points in the history:
- When did their symptoms start? (<7?)
- Impulsive? Inattentive? Hyperactive? (Elicit examples)
- Does these issues present at school, at home, and when he tries to socialise?
- Explore possible causes of the behaviour
- Ask about family history of ADHD
- Ask the mother about her ideas, concerns and expectations with regards to his behaviour
What is ADHD?
- ADHD stands for Attention Deficit Hyperactivity Disorder
- It is a behavioural disorder
- It affects more males than females (ratio of 3:1)
- 2% of children are affected in the UK
- It normally occurs in childhood by age 7
- Symptoms should have lasted for over 6 months in order to make the diagnosis
- Symptoms include:
- Impulsivity
- Inattention
- Hyperactivity
- Impaired functioning
- I.e.: may affect a child's schooling and relationships with family and friends
- And should affect the child in more than one domain in their life (e.g. at home and at school)
What is the cause of ADHD?
- A mixture of factors are suspected to contribute to ADHD formation. This includes;
- Genes - a family history of ADHD may be present
- Environmental
- Social deprivation and neglect in childhood
- Neurodevelopmental abnormalities
- Includes mother drinking alcohol and taking drugs such as heroin during pregnancy (BEWARE: don't make this sound like you are accusing or judging the mother if you say this)
- Includes obstetric complications
- Includes a low birth weight of the child
What is the treatment for ADHD?
- Family education and support
- Parent training programme
- school education and support
- teachers may meet with parents and psychiatrist to discuss support in school
- Family and individual therapy
- Family therapy
- CBT
- Social awareness therapy
- Behavioural treatment
- Rewarding good behaviour and discouraging bad behaviour
- Medication
- Only in children over 6 years old
- Methylphenidate, i.e.: Ritalin is most commonly used
- This increases dopamine in the brain, which is thought to improve concentration and reduce hyperactivity
- Titrate medication up over time
- Drug given 3 times a day at first. The short acting methylphenidate begins working within about 20 minutes and lasts for 3-4 hours.Once at a therapeutic dose, a longer acting version of the drug may be used, taken once per day
- Child is monitored for side effectS
- Side effects include: headaches, insomnia, appetite decrease, poor weight gain if taken long term
- Child should be reviewed every 6 months. It is recommended that the doctor also check your child's height, weight and blood pressure.
- Most children will need to continue medication through high school. Once children become teenagers, some doctors will recommend a trial off the medication each year. This is to make sure that medication is still necessary.
- If methylphenidate does not work, other drugs are available, e.g.: Modafenil, which can be discussed more in the future if needed.
- It is shown that 1/3 children resolve with treatment
Is he ever going to get better?
- Prognosis is variable
- Gradual improvement occurs in adolescence, but up to 8 in 10 children with ADHD will continue to experience some symptoms into their teenage years e.g.: restlessness and inattention
- However, early and consistent treatment improves this prognosis.
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written by: celine_lakra,
first posted on: 19/03/12, 21:29
first posted on: 19/03/12, 21:29
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