Unit4: Epilepsy and ADHD
4.1 Concept and definition of Epilepsy.
4.2 Concept and definition of ADHD
4.3 Management Strategies for persons with Epilepsy.
4.4 Assessment and management of persons with ADHD
4.5 Hyperactivity – Emotional disorders, concept, characteristics, Classroom management
4.1 Concept and definition of Epilepsy.
The Centers for Disease Control and Prevention (CDC) describe epilepsy as “a common brain condition that causes repeated seizures.”
Epilepsy is a condition in which a person has recurrent seizures. A seizure is defined as an abnormal, disorderly discharging of the brain's nerve cells, resulting in a temporary disturbance of motor, sensory, or mental function.
There are many types of seizures, depending primarily on what part of the brain is involved. The term epilepsy says nothing about the type of seizure or cause of the seizure, only that the seizures happen again and again. A stricter definition of the term requires that the seizures have no known underlying cause. This may also be called primary or idiopathic epilepsy.
Epilepsy Causes
Healthy people may have seizures under certain circumstances. If the seizures have a known cause, the condition is referred to as secondary or symptomatic epilepsy. Some of the more common causes include the following:
4.2 Concept and definition of ADHD
Attention deficit hyperactivity disorder (ADHD) is a neurological disorder that impacts the parts of the brain that help us plan, focus on, and execute tasks. ADHD symptoms vary by sub-type — inattentive, hyperactive, or combined — and are often more difficult to diagnose in girls and adults. Here, we review the symptoms, causes, types, and tests associated with attention deficit hyperactivity disorder.
The Diagnostic and Statistical Manual of Mental Disorders (DSM)5previously identified three types of ADHD:
People with hyperactive-impulsive subtype of ADHD act “as if driven by a motor” with little impulse control — moving, squirming, and talking at even the most inappropriate times. They are impulsive, impatient, and interrupt others.
People with the inattentive subtype of ADHD are easily distracted and forgetful. They may be daydreamers who lose track of homework, cell phones, and conversations with regularity.
Individuals with combined-type ADHD display a mixture of all the symptoms outlined above.
These subtypes are now considered “presentations” in the most recent version of the DSM, the DSM-V. Researchers determined that people often move from one subtype to another. For example, a child may present as primarily hyperactive-impulsive in preschool, and lose much of the hyperarousal in adolescence to fit the primarily inattentive presentation. In college and adulthood, the same individual may transition to combined presentation.
The subtypes were primarily based on overt behavioral symptoms, and ignored less visible symptoms like emotional dysregulation, cognitive patterns, and sleep difficulties. Behavioral symptoms imperfectly capture the defining features of ADHD. Non-behavioral characteristics are increasingly recognized in research and diagnosis.
ADHD is, instead, a developmental impairment of the brain’s self-management system. Common ADHD symptoms include:
4.3 Management Strategies for persons with Epilepsy.
Most people can manage epilepsy. Your treatment plan will be based on severity of symptoms, your health, and how well you respond to therapy.
Some treatment options include:
Research into new treatments is ongoing. One treatment that may be available in the future is deep brain stimulation. It’s a procedure in which electrodes are implanted into your brain. Then a generator is implanted in your chest. The generator sends electrical impulses to the brain to help decrease seizures.
Another avenue of research involves a pacemaker-like device. It would check the pattern of brain activity and send an electrical charge or drug to stop a seizure.
Minimally invasive surgeries and radiosurgery are also being investigated.
The first-line treatment for epilepsy is antiseizure medication. These drugs help reduce the frequency and severity of seizures. They can’t stop a seizure that’s already in progress, nor is it a cure for epilepsy.
The medication is absorbed by the stomach. Then it travels the bloodstream to the brain. It affects neurotransmitters in a way that reduces the electrical activity that leads to seizures.
Antiseizure medications pass through the digestive tract and leave the body through urine.
There are many antiseizure drugs on the market. Your doctor can prescribe a single drug or a combination of drugs, depending on the type of seizures you have.
Common epilepsy medications include:
These medications are generally available in tablet, liquid, or injectable forms and are taken once or twice a day. You’ll start with the lowest possible dose, which can be adjusted until it starts to work. These medications must be taken consistently and as prescribed.
Some potential side effects may include:
Rare, but serious side effects include depression and inflammation of the liver or other organs.
Epilepsy is different for everybody, but most people improve with antiseizure medication. Some children with epilepsy stop having seizures and can stop taking medication.
If medication can’t decrease the number of seizures, another option is surgery.
The most common surgery is a resection. This involves removing the part of the brain where the seizures start. Most often, the temporal lobe is removed in a procedure known as temporal lobectomy. In some cases, this can stop seizure activity.
In some cases, you’ll be kept awake during this surgery. That’s so doctors can talk to you and avoid removing part of the brain that controls important functions such as vision, hearing, speech, or movement.
If the area of the brain is too big or important to remove, there’s another procedure called multiple subpial transection, or disconnection. The surgeon makes cuts in the brain to interrupt the nerve pathway. That keeps seizures from spreading to other areas of the brain.
After surgery, some people are able to cut down on antiseizure medications or even stop taking them.
There are risks to any surgery, including a bad reaction to anesthesia, bleeding, and infection. Surgery of the brain can sometimes result in cognitive changes. Discuss the pros and cons of the different procedures with your surgeon and seek a second opinion before making a final decision.
4.4 Assessment and management of persons with ADHD
There's no single test to diagnose ADHD. Instead, doctors rely on several things, including:
The doctor needs to see how much a person’s symptoms are affecting his daily moods, behavior, productivity, and lifestyle habits. And he needs to rule out other conditions.
With children, the doctor will talk with the parents about ADHD symptoms they have seen. The doctor will want to know what age the behaviors began and where and when the child shows symptoms. The doctor may ask for a behavior report from the child's teacher, report cards, and samples of schoolwork.
With adults, the doctor may want to talk with a spouse or other family members. He'll want to find out if they had symptoms in childhood. Knowing if an adult had ADHD behavior as a child is important for making a diagnosis.
To diagnose ADHD, doctors most often use guidelines established by the American Psychiatric Association. The group has identified 3 types of the disorder:
1. Inattentive Type: A person must have at least 6 out of these 9 symptoms, and few symptoms of hyperactive-impulsive type:
2. Hyperactive-Impulsive Type: A person must have at least 6 out these 9 symptoms, and few symptoms of inattentive type:
3. Combined Type. This is the most common type of ADHD. People with it have symptoms of both inattention and hyperactivity-impulsivity.
Along with these APA guidelines, doctors may also use rating scales to help them evaluate and track ADHD symptoms. A few examples are
Management of ADHD
A group of drugs called psychostimulants has been found to be the most effective treatment for childhood ADHD. The two most commonly used medicines in this class are methylphenidate (Ritalin®, Concerta®, Focalin XR®, Ritalin LA®, Daytrana®, Quillivant XRTM, Metadate CD) and dextroamphetamine (Adderall XR®, Vyvanse®). These medicines help children to focus their thoughts and ignore distractions. Stimulant medicines are effective in 70% to 80% of patients.
Non-stimulant medicines include atomoxetine (Strattera®,) guanfacine (Intuniv®), and clonidine (Kapvay®). They are often used as additional therapy, or can be used on their own if the doctor decides.
Here is a current list of ADHD medications:
Methylphenidate
Amphetamine
ADHD medicines are available in short-acting (immediate-release), intermediate-acting, and long-acting forms. It might take some time for a doctor to find the most effective medicine, dosage, and schedule for a person who has ADHD.
There is no reliable way to predict which medicine(s) will work. The only way to know that a medication will be helpful for a child with ADHD is to prescribe it.
ADHD drugs sometimes have side effects, including appetite suppression, trouble sleeping, or irritability. Side effects are often mild and short-lived, and usually happen early in treatment. If side effects continue or interfere with the child’s life, the doctor will probably change the medication or lower the dose of the medicine used. A good rule is to compare the benefit of medicine to the side effect—if the benefit outweighs the side effect, it is often helpful to manage the side effect.
Behavioral treatments for ADHD include the following:
Parents should use caution when considering alternative treatments. Very few alternative or complementary treatments have been shown to be helpful for ADHD.
The program Cogmed is effective in training working memory, which is often a problem with children who have ADHD. Other studies have shown mild benefits for omega-3 supplements, massage therapy, and mindfulness training. Mindfulness training is proving to be a real asset in many therapies, including ADHD.
Other alternative treatments for ADHD that have not been proven useful in controlled scientific studies, or may even be harmful, are:
Though many claims are made for other complementary and alternative treatments for ADHD, such as Brain Gym and Lumosity, few have been found to be effective.
4.5 Hyperactivity – Emotional disorders, concept, characteristics, Classroom management
Children occasionally act angry or defiant around adults or respond aggressively when they are upset. When these behaviors persist over time, or are severe, they can become a behavior disorder. Children with ADHD are more likely than other children to be diagnosed with a behavior disorder such as Oppositional Defiant Disorder or Conduct Disorder.
When children act out persistently so that it causes serious problems at home, in school, or with peers, they may be diagnosed with Oppositional Defiant Disorder (ODD). ODD is one of the most common disorders occurring with ADHD. ODD usually starts before 8 years of age, but can also occur in adolescents. Children with ODD may be most likely to act oppositional or defiant around people they know well, such as family members or a regular care provider. Children with ODD show these behaviors more often than other children their age.
Examples of ODD behaviors include
Conduct Disorder (CD) is diagnosed when children show a behavioral pattern of aggression toward others, and serious violations of rules and social norms at home, in school, and with peers. These behaviors can lead to breaking the law and being jailed. Having ADHD makes a child more likely to be diagnosed with CD. Children with CD are more likely than other children to get injured, and to have difficulties getting along with peers.
Examples of CD behaviors include
Starting treatment early is important. Treatment is most effective if it fits the needs of the child and family. The first step to treatment is to have a comprehensive evaluation by a mental health professional. Some of the signs of behavior problems, such as not following rules, are also signs of ADHD, so it is important to get a careful evaluation to see if a child has both conditions. For younger children, the treatment with the strongest evidence is behavioral parent training, where a therapist helps the parent learn effective ways to strengthen the parent-child relationship and respond to the child’s behavior. For school-age children and teens, an often-used effective treatment is combination training and therapy that includes the child, the family, and the school. Sometimes medication is part of the treatment.
Many children have fears and worries. However, when a child experiences so many fears and worries that they interfere with school, home, or play activities, it is an anxiety disorder. Children with ADHD are more likely than those without to develop an anxiety disorder.
Examples of anxiety disorders include
Occasionally being sad or feeling hopeless is a part of every child’s life. When children feel persistent sadness and hopelessness, it can cause problems. Children with ADHD are more likely than children without ADHD to develop childhood depression. Children may be more likely to feel hopeless and sad when they can’t control their ADHD symptoms and the symptoms interfere with doing well at school or getting along with family and friends.
Examples of behaviors often seen when children are depressed include
Children with ADHD often have a hard time focusing on things that are not very interesting to them. Depression can make it hard to focus on things that are normally fun. Changes in eating and sleeping habits can also be a sign of depression. For children with ADHD who take medication, changes in eating and sleeping can also be side-effects from the medication rather than signs of depression. Talk with your healthcare provider if you have concerns.
The first step to treatment is to talk with a healthcare provider to get an evaluation. Some signs of depression, like having a hard time focusing, are also signs of ADHD, so it is important to get a careful evaluation to see if a child has both conditions. A mental health professional can develop a therapy plan that works best for the child and family. Early treatment is important, and can include child therapy, family therapy, or a combination of both. The school can also be included in therapy programs. For very young children, involving parents in treatment is very important. Cognitive behavioral therapy is one form of therapy that is used to treat anxiety or depression, particularly in older children. It helps the child change negative thoughts into more positive, effective ways of thinking. Consultation with a health provider can help determine if medication should also be part of the treatment.
ADHD can make peer relationships or friendships very difficult. Having friends is important to children’s well-being and may be very important to their long-term development.
Although some children with ADHD have no trouble getting along with other children, others have difficulty in their relationships with their peers; for example, they might not have close friends, or might even be rejected by other children. Children who have difficulty making friends might also more likely have anxiety, behavioral and mood disorders, substance abuse, or delinquency as teenagers.
Exactly how ADHD contributes to social problems is not fully understood. Children who are inattentive sometimes seem shy or withdrawn to their peers. Children with symptoms of impulsivity/hyperactivity may be rejected by their peers because they are intrusive, may not wait their turn, or may act aggressively. In addition, children with ADHD are also more likely than those without ADHD to have other disorders that interfere with getting along with others.
Not everyone with ADHD has difficulty getting along with others. For those children who do have difficulty, many things can be done to help them with relationships. The earlier a child’s difficulties with peers are noticed, the more successful intervention may be. Although researchers don’t have definitive answers on what works best for children with ADHD, some things parents might consider as they help their child build and strengthen peer relationships are:
There are some school-based management strategies shown to be effective for ADHD students: behavioral classroom management and organizational training.
The behavioral classroom management approach
encourages a student’s positive behaviors in the classroom, through a reward
systems or a daily report card, and discourages their negative behaviors. This
teacher-led approach has been shown to influence student behavior in a
constructive manner, increasing academic engagement. Although tested mostly in
elementary schools, behavioral classroom management has been shown to work
students of all ages.1
Organizational
training teaches children time management, planning
skills, and ways to keep school materials organized in order to optimize
student learning and reduce distractions. This management strategy has been
tested with children and adolescents.1
These two management strategies require trained staff—including teachers, counselors, or school psychologists—follow a specific plan to teach and support positive behavior.
The American Academy of Pediatrics (AAP) recommends that the school environment, program, or placement is a part of any ADHD treatment plan. AAP also recommends teacher-administered behavior therapy as a treatment for school-aged children with ADHD.