Presentation on ADHD (Attention-Deficit/Hyperactivity Disorder) with Case

Studies

Slide 1: Title Slide

 Title: Understanding ADHD: A Comprehensive Overview with Case Studies

 Subtitle: Causes, Symptoms, Diagnosis, and Treatment
 Presented by: [Your Name]

Slide 2: Introduction to ADHD

 Definition: ADHD is a neurodevelopmental disorder characterized by inattention,

hyperactivity, and impulsivity.
 Prevalence: Affects about 5-10% of children worldwide; can persist into adulthood.
 Importance: Early identification and management are crucial for improving quality of
life.

Slide 3: Types of ADHD

1. Inattentive Type: Primarily struggles with focus and attention.

o Symptoms: Difficulty organizing tasks, losing items, easily distracted.
2. Hyperactive-Impulsive Type: Characterized by excessive activity and impulsive
actions.
o Symptoms: Fidgeting, trouble sitting still, interrupting others.
3. Combined Type: Both inattention and hyperactivity/impulsivity are present.

Slide 4: Symptoms of ADHD

 Inattention:
o Difficulty sustaining focus in tasks or play.
o Easily distracted by irrelevant stimuli.
o Forgetfulness in daily activities.
 Hyperactivity:
o Excessive talking or inability to remain seated.
o Climbing or running when not appropriate.
 Impulsivity:
 o Difficulty waiting for turns.
o Blurting out answers before questions are completed.

Slide 5: Case Study 1: Adolescent with ADHD (Hyperactive-Impulsive Type)

 Patient Profile: Sarah, a 13-year-old girl.

 Background: Hyperactive and talkative in class, disrupts others.
 Symptoms:
o Constant fidgeting and restlessness.
o Frequently interrupts conversations.
o Trouble waiting her turn in social settings.
 Diagnosis: Hyperactive-Impulsive ADHD, identified through clinical assessment.
 Treatment:
o Cognitive Behavioral Therapy (CBT) for impulse control.
o Classroom interventions (e.g., scheduled breaks).
o Medication as needed.

Slide 7: Causes and Risk Factors

 Genetic Factors: ADHD tends to run in families; higher risk if a close relative has the
disorder.
 Environmental Factors: Exposure to tobacco or alcohol during pregnancy, premature
birth, and low birth weight.
 Brain Structure: Differences in the brain’s structure and neurotransmitter function,
especially dopamine, contribute to symptoms.

Slide 8: Diagnosis of ADHD

 Assessment Tools:
o Clinical interviews with parents, teachers, and the child.
o Standardized behavioral rating scales (e.g., Conners' ADHD Rating Scale).
 Criteria: According to DSM-5, symptoms must be present for at least 6 months, appear
before age 12, and impact functioning in two or more settings (e.g., home and school).

Slide 9: Case Study 3: Adult with ADHD

 Patient Profile: Michael, a 32-year-old man.

 Background: Difficulty managing work deadlines, impulsive spending.
  Symptoms:
o Trouble organizing tasks at work.
o Impulsive decision-making, leading to financial stress.
o History of academic difficulties as a child.
 Diagnosis: Adult ADHD diagnosed via self-reports and past medical history.
 Treatment:
o Medication (stimulants or non-stimulants).
o Organizational coaching and time management strategies.
o Therapy to manage impulsivity.

Slide 10: Treatment Options for ADHD

1. Medication:
o Stimulants: Methylphenidate, amphetamines.
o Non-stimulants: Atomoxetine, guanfacine.
2. Behavioral Therapy:
o Focus on improving organizational skills, time management.
o Positive reinforcement and social skills training.
3. Lifestyle Interventions:
o Physical activity, healthy diet, structured routines.
o Mindfulness and stress management techniques.

Slide 11: Challenges and Stigma

 Misconceptions: ADHD is often misunderstood as a lack of discipline or motivation.

 Stigmatization: Children and adults with ADHD may face social isolation, bullying, or
job discrimination.
 Solution: Awareness campaigns, educating parents, teachers, and employers about the
realities of ADHD.

Slide 12: Conclusion

 ADHD is a complex disorder affecting both children and adults.

 With proper diagnosis and a combination of treatment approaches, individuals with
ADHD can lead productive and fulfilling lives.
 Early intervention is key to better outcomes in education, social relationships, and work
performance.
Slide 13: Q&A

 Open for Questions: Engage the audience, offer additional insights or discuss the case
studies further.

ADHD Case Conceptualization

A case conceptualization provides a structured way to understand an individual’s experience

with ADHD by examining the various factors that contribute to the diagnosis. This process
typically involves integrating biological, psychological, and social elements to create a clear
picture of the patient’s challenges and guide treatment. Below is a detailed ADHD case
conceptualization template, including various components and how they are interlinked.

1. Client Overview

 Name: Sarah
 Age: 13 years old
 Presenting Problem: Disruptive behavior in class, trouble focusing, frequent fidgeting,
interrupting others, poor academic performance.

2. Key ADHD Symptoms

 Inattention:
o Difficulty focusing on schoolwork.
o Often forgets to complete or turn in homework assignments.
o Easily distracted by external stimuli in class.
 Hyperactivity:
o Excessive talking during lessons.
o Frequently leaves her seat in the classroom, especially during quiet activities.
o Restless, cannot sit still during family dinners or when watching TV.
 Impulsivity:
o Interrupts conversations, blurts out answers before questions are completed.
o Difficulty waiting her turns during group activities.
o Makes impulsive decisions, such as leaving tasks incomplete to start new
activities.

3. Biological Factors
  Family History: ADHD diagnosis in Sarah’s father; her younger brother is also showing
early signs of inattention.
 Genetics: Given that ADHD runs in families, Sarah is at a higher risk due to her father’s
history of ADHD.
 Brain Structure & Neurotransmitters: ADHD is associated with dysregulation in
dopamine, affecting Sarah’s reward system and ability to focus. This may contribute to
her difficulty in maintaining attention and controlling impulsive behaviors.

4. Psychological Factors

 Self-Esteem Issues: Sarah feels that she is not as capable as her peers, especially in
academic settings. This is further impacted by her frequent mistakes and inability to
complete tasks, leading to frustration and self-criticism.
 Cognitive Distortions: She believes that she “isn’t smart enough” and sometimes avoids
challenging tasks, thinking that she will fail before even trying.
 Emotional Dysregulation: Sarah experiences sudden outbursts of frustration when she
cannot focus on or complete tasks, which exacerbates her impulsive behavior and further
isolates her from her peers.

5. Social Factors

 School Environment:
o Sarah’s teachers report difficulty managing her behaviors in the classroom. Other
students have started distancing themselves from Sarah due to her disruptive
tendencies.
o Teachers have noted that while Sarah is bright, her inattentiveness and
hyperactive behaviors prevent her from performing at her true potential.
 Family Environment:
o Her parents are concerned about her behavior but are often inconsistent in
applying discipline or structure at home.
o Parental expectations are high, but communication around ADHD has been
limited. Her father, having ADHD himself, sometimes struggles with providing
the necessary support.
 Peer Relationships:
o Sarah’s impulsive actions and inability to wait her turn lead to frequent conflicts
with classmates. As a result, she has fewer friends and experiences social
isolation.
o She is sensitive to peer rejection, which intensifies her feelings of low self-worth.

6. Behavioral Patterns
  Avoidance of Tasks: Sarah often avoids activities that require sustained mental effort
(e.g., reading or completing assignments).
 Disorganization: Her school materials are often misplaced, and she struggles to follow a
schedule, resulting in incomplete assignments and missed deadlines.
 Disruptive Outbursts: She reacts impulsively when corrected or asked to change her
behavior, often leading to arguments or defiance at school and at home.

7. Strengths and Protective Factors

 Intelligence and Creativity: Sarah is noted by her teachers to be exceptionally creative,

especially in arts and storytelling. When she’s interested in a topic, she can focus for
longer periods.
 Supportive Family: Despite some inconsistencies, her parents are generally supportive
and are seeking help to address her challenges.
 Motivation to Succeed: Sarah is eager to do well in school, even though she struggles
with maintaining focus and organization. She has expressed a desire to “do better” in her
studies and social relationships.

8. Formulation (How these factors come together)

Sarah’s ADHD likely stems from a biological predisposition (family history and genetic
factors) that influences her brain function, particularly in the regulation of attention, impulsivity,
and hyperactivity. These neurobiological factors manifest in inattention and hyperactive-
impulsive behaviors, which create significant challenges in school and social settings.

Psychologically, Sarah experiences feelings of frustration and inadequacy, which are

compounded by her academic struggles. These feelings contribute to her emotional
dysregulation and further reinforce impulsive actions. Her cognitive distortions about her
abilities (e.g., “I’m not smart enough”) perpetuate a cycle of avoidance and low self-esteem.

In her social environment, Sarah’s difficulties are intensified by her lack of peer support and the
negative feedback from teachers, leading to isolation. Her parents, though supportive, have
inconsistent methods of managing her behaviors, which exacerbates her ADHD symptoms.

9. Treatment Plan

1. Cognitive Behavioral Therapy (CBT):

o Focus on addressing Sarah’s cognitive distortions around failure and low self-
esteem.
o Teach coping strategies for emotional regulation and managing impulsivity.
 2. Behavioral Interventions:
o Implement structured routines at home and in school.
o Use positive reinforcement to encourage task completion and focus on
incremental successes.
o Set clear expectations and rewards for waiting turns and completing tasks.
3. Parental Coaching:
o Work with Sarah’s parents to create consistent discipline and structure at home.
o Educate parents on ADHD management strategies and how to provide
constructive feedback.
4. School Accommodations:
o Create a behavior intervention plan with Sarah’s teachers that includes regular
breaks, extended time for assignments, and seating arrangements to reduce
distractions.
o Provide an Individualized Education Program (IEP) or a 504 plan that addresses
her ADHD-related needs.
5. Medication (if applicable):
o Consider a trial of stimulant medication (e.g., methylphenidate) or non-stimulants
(e.g., atomoxetine) under the guidance of a pediatrician or psychiatrist to help
manage symptoms of inattention and impulsivity.

10. Conclusion

This conceptualization highlights how Sarah’s ADHD is influenced by a combination of genetic,

psychological, and environmental factors. Through a comprehensive treatment plan that includes
therapy, family support, school interventions, and potentially medication, Sarah can improve her
academic performance, emotional regulation, and peer relationships.

The 4P Model in case formulation is a comprehensive framework used to conceptualize an

individual’s psychological problems by understanding the factors that contribute to their
development, maintenance, and expression. It consists of four components: Predisposing,
Precipitating, Perpetuating, and Protective factors. Below is a breakdown of how this model
applies to a case of ADHD.

4P Model Case Conceptualization: ADHD

1. Predisposing Factors

These are factors that increase the individual’s vulnerability to developing ADHD. They usually
include genetic, biological, and environmental influences that set the stage for ADHD
symptoms.
  Genetics: Sarah has a family history of ADHD, with her father being diagnosed as a
child. This genetic predisposition increases her likelihood of developing ADHD.
 Prenatal and Early Developmental Factors: It was noted that her mother experienced
stress during pregnancy, and Sarah was born slightly prematurely, factors that may
contribute to neurodevelopmental risks.
 Brain Structure and Functioning: ADHD is associated with structural differences in
the brain, particularly in areas related to dopamine regulation and executive
functioning (e.g., the prefrontal cortex). Sarah’s difficulties with attention and
impulsivity may be linked to these neurological factors.

2. Precipitating Factors

These are events or conditions that trigger the onset of ADHD symptoms or lead to their
exacerbation. They are often recent stressors or changes in the individual’s life that contribute to
the presentation of ADHD.

 Academic Pressures: Sarah's academic demands have increased in middle school. The
need to focus on longer, more complex assignments has made her difficulties with
attention more apparent.
 Social Isolation: Sarah's impulsive behavior and inability to wait her turn have led to
conflicts with peers. The resulting social isolation and rejection have worsened her self-
esteem and emotional dysregulation.
 Parental Inconsistencies: While her parents are supportive, they have difficulty
providing a consistent structure at home, leading to increased confusion and frustration in
Sarah, and particularly regarding expectations around schoolwork.

3. Perpetuating Factors

These are factors that maintain or worsen ADHD symptoms over time, contributing to the
chronic nature of the disorder.

 Cognitive Distortions: Sarah has developed negative thought patterns, such as thinking
she is "not smart enough" because of her struggles in school. This belief leads her to
avoid tasks that require sustained attention, further worsening her academic performance.
 Negative Peer Interactions: Her impulsive behaviors in social settings lead to conflicts,
which results in further peer rejection. This reinforces her feelings of isolation and
frustration, perpetuating her emotional dysregulation and impulsivity.
 Inconsistent Structure at Home: Her parents’ lack of consistent strategies to help her
stay organized and manage her symptoms has led to increased stress at home. This
inconsistency makes it harder for Sarah to develop coping strategies for managing ADHD
symptoms.
  Avoidance of Tasks: Sarah avoids tasks that require sustained mental effort, such as
homework, which reinforces her disorganization and poor academic performance.
Avoidance perpetuates her symptoms, making it harder for her to focus and complete
assignments.

4. Protective Factors

These are strengths or resources that help mitigate the effects of ADHD and improve the
individual’s functioning and outcomes.

 Supportive Parents: While inconsistent at times, Sarah’s parents are generally

supportive and motivated to seek help for her. They are open to interventions, which
could lead to positive outcomes with proper guidance.
 Intelligence and Creativity: Sarah has strong creative abilities and shows interest in
subjects like art and storytelling. Her engagement in these areas can be used as a strength
in therapy and academic settings.
 School Support: Sarah's teachers have noticed her potential and are working with her
parents to implement classroom accommodations (e.g., extra time for assignments,
movement breaks). This support could lead to improvement in her academic
performance.
 Desire to Improve: Sarah is motivated to do better in school and socially, which
provides a solid foundation for engaging her in therapeutic interventions and making
behavioral changes.

Summary of Case Using the 4P Model

 Predisposing Factors: Genetic predisposition to ADHD, prenatal complications, and

neurological differences affecting dopamine regulation and executive functioning.
 Precipitating Factors: Academic stress, social isolation, and inconsistent parenting
strategies that triggered the more pronounced onset of symptoms during adolescence.
 Perpetuating Factors: Cognitive distortions, negative peer interactions, task avoidance,
and inconsistent structure at home that contribute to the maintenance of ADHD
symptoms.
 Protective Factors: Supportive parents, creative strengths, school accommodations, and
Sarah’s personal motivation to improve, all of which provide opportunities for effective
intervention.

This 4P Model helps to understand the full scope of Sarah's ADHD, identifying factors that led
to its development, what is maintaining it, and where potential strengths lie for treatment
interventions.
Formal and Informal Assessment of ADHD Case

When assessing ADHD, a combination of formal and informal assessments is essential to

gather a comprehensive understanding of the client’s symptoms and challenges. Below is a
breakdown of both approaches applied to Sarah’s case:

1. Formal Assessment of ADHD

Formal assessments involve structured, standardized tools that can be used to diagnose ADHD.
These tools typically assess attention, impulsivity, hyperactivity, and other behavioral patterns.
Here’s how Sarah’s assessment can be approached formally:

A. Clinical Interviews

 Structured Diagnostic Interview:

o Interview Sarah, her parents, and teachers using a standardized diagnostic tool
like the K-SADS-PL (Kiddie Schedule for Affective Disorders and Schizophrenia
for School-Age Children - Present and Lifetime Version) or Diagnostic
Interview for ADHD.
o Focus on symptoms across settings (home, school, social) to ensure ADHD
criteria are met according to the DSM-5.
o Assess the duration and impact of symptoms, ensuring they have persisted for
over six months and occurred before age 12.

B. ADHD-Specific Rating Scales

 Conners’ Rating Scale:

o Administer the Conners’ Rating Scale to both parents and teachers. This is a
validated tool to assess ADHD symptoms such as inattention, hyperactivity, and
impulsivity.
o Sarah’s scores on this scale will be compared to normative data to determine
whether her behaviors are consistent with an ADHD diagnosis.
 Vanderbilt ADHD Diagnostic Rating Scale:
o Another widely used tool, completed by Sarah’s teachers and parents, to assess
ADHD symptoms and their impact on academic performance, classroom
behavior, and social interactions.

C. Cognitive and Academic Assessments

 WISC-V (Wechsler Intelligence Scale for Children):

o Administering an IQ test like the WISC-V helps assess Sarah’s cognitive
strengths and weaknesses. This can be useful in distinguishing ADHD from other
learning disabilities.
 oIt can also highlight areas of processing speed and working memory, often
impaired in children with ADHD.
 Woodcock-Johnson Achievement Test:
o This test will assess Sarah’s academic skills in areas like reading, math, and
written language, providing data on whether her academic struggles are primarily
due to ADHD or another learning disorder.

D. Continuous Performance Tests (CPT)

 Test of Variables of Attention (TOVA) or Conners’ Continuous Performance Test

(CPT):
o These computerized tests measure sustained attention, impulsivity, and reaction
time. They can be used to objectively measure Sarah’s difficulties in maintaining
focus and resisting impulses.

E. Functional Impairment Assessment

 Children’s Global Assessment Scale (CGAS):

o This tool assesses Sarah’s overall functioning across different life domains (home,
school, social). It provides an overview of how ADHD affects her day-to-day
functioning.

2. Informal Assessment of ADHD

Informal assessments involve observations, interviews, and unstructured tools that provide
insights into Sarah’s behaviors and challenges in natural settings. These assessments often
complement formal tools by offering a more nuanced understanding of the individual’s
functioning.

A. Behavioral Observations

 Classroom Observations:
o Observe Sarah in her classroom setting during activities that require sustained
attention (e.g., during a reading or math lesson).
o Look for fidgeting, inattention, disruptive behavior, and impulsivity (e.g.,
blurting out answers, leaving her seat without permission).
 Home Environment:
o Conduct an informal home observation or ask parents to keep a behavior log.
Assess how Sarah behaves during homework time, meals, or free play. Focus on
how well she can follow instructions, stay organized, and manage her impulses in
an unstructured environment.

B. Parent and Teacher Interviews

  Unstructured Interviews:
o Conduct open-ended interviews with her parents and teachers to gather detailed
information about Sarah’s behavior patterns.
o Ask questions about routine disruptions, academic challenges, and
interpersonal struggles at home and in school.
o Explore specific incidents where Sarah’s impulsivity or inattention caused
significant challenges.

C. Self-Report from the Client

 Self-Assessment:
o For older children like Sarah (age 13), a self-report ADHD questionnaire can be
used. While she might not fully recognize all symptoms, asking her how she
perceives her own attention, organization, and behavior can offer important
insights.
o Use a simplified self-report scale or ask her about situations where she feels she
can’t focus or struggles with self-control.

D. Work Samples & Daily Functioning

 Academic Work Samples:

o Collect samples of Sarah’s schoolwork, especially incomplete assignments or
tasks where she struggled with focus. This can offer a practical look at her
academic difficulties related to attention and organization.
 Daily Routines:
o Review Sarah’s daily routines (morning, school, homework, bedtime) with her
parents. How well is she able to complete tasks without being prompted? Does
she have difficulty transitioning between activities, especially those requiring
sustained mental effort?

E. Social Interactions

 Peer Relationships:
o Evaluate Sarah’s social functioning through informal assessments (interviewing
Sarah and her peers, observing her in social situations). Her impulsivity may
affect her ability to maintain friendships, and these observations can provide
insight into the impact of ADHD on her social life.

Summary: Formal and Informal Assessment Integration

Formal Assessment Findings:

 Based on the Conners’ Rating Scale and cognitive tests (e.g., WISC-V), Sarah presents
with significant difficulties in attention, organization, and impulsivity that are
 impacting her academic performance. The Vanderbilt ADHD Rating Scale results
suggest that her symptoms are more pronounced in the hyperactive-impulsive subtype
of ADHD.
 CPT results might show impairments in sustained attention and inhibitory control,
which are common markers of ADHD.

Informal Assessment Findings:

 Classroom observations reveal that Sarah often leaves her seat and interrupts others. She
struggles with completing tasks during quiet activities, which aligns with the hyperactive-
impulsive type of ADHD.
 Parent interviews suggest difficulties in maintaining consistent routines at home,
contributing to Sarah’s disorganization and emotional outbursts. Social isolation due to
impulsive behavior with peers has also been noted.

By integrating both formal and informal assessments, a comprehensive understanding of Sarah’s

ADHD can be formed. This multidimensional approach ensures that the diagnosis is accurate and
that the treatment plan addresses not only her academic challenges but also her emotional, social,
and home life difficulties.

When diagnosing ADHD, it's important to distinguish it from other conditions that may present
with similar symptoms. These conditions must be considered in a differential diagnosis to avoid
misdiagnosis and to ensure appropriate treatment. Below are some common conditions that may
overlap with ADHD and need to be differentiated:

1. Anxiety Disorders

 Similarities:
o Inattention: Children with anxiety may appear inattentive, especially when they
are preoccupied with worry.
o Restlessness: Anxiety can also cause physical restlessness, which might look like
hyperactivity.
 Differences:
o Anxiety tends to be situation-specific (e.g., only in certain contexts or around
specific fears), whereas ADHD symptoms are more pervasive across different
settings.
o Anxious children often display avoidance behaviors due to worry, while children
with ADHD avoid tasks due to boredom or difficulty concentrating.

2. Oppositional Defiant Disorder (ODD)

 Similarities:
 o Impulsivity: Both ODD and ADHD can manifest with impulsive, disruptive
behaviors.
o Problems with authority: Children with ODD may exhibit non-compliance and
defiance, which can also be seen in some cases of ADHD.
 Differences:
o Intentionality: In ODD, defiant behavior is often deliberate and aimed at
opposing authority, whereas children with ADHD may unintentionally behave
disruptively due to impulsivity or inattention.
o Children with ODD may not show the classic signs of inattention or
hyperactivity unless they also have ADHD.

3. Learning Disabilities (LD)

 Similarities:
o Poor academic performance: Children with LDs may have trouble keeping up in
school, similar to children with ADHD.
o Inattention: Difficulties with processing information in learning-disabled children
may mimic the inattention seen in ADHD.
 Differences:
o LDs usually involve specific academic challenges (e.g., reading, writing, math),
whereas ADHD affects a broader range of behaviors, including attention, impulse
control, and hyperactivity.
o A child with ADHD may struggle across all academic tasks due to lack of focus,
while a child with an LD may show deficits in only one subject area.

4. Depression

 Similarities:
o Inattention: Depression can lead to concentration difficulties, which might be
confused with ADHD inattention.
o Fatigue and lack of motivation: Depressed children may appear disinterested or
inattentive due to low energy.
 Differences:
o Mood disturbances: Depression is often marked by persistent sadness or
irritability, while ADHD usually lacks the pervasive negative mood component.
o Depressed children may exhibit slowed thinking and activity, which contrasts
with the hyperactivity seen in ADHD.

5. Autism Spectrum Disorder (ASD)

 Similarities:
o Difficulty focusing and staying on task: Both conditions can involve inattention
and impulsivity.
o Social challenges: Children with ASD and ADHD may both struggle with peer
relationships and social skills.
 Differences:
 o Restricted interests and repetitive behaviors are hallmark features of ASD but
are not present in ADHD.
o Children with ASD often struggle with social communication in ways that are
more pervasive and complex than those with ADHD, who tend to have issues
more related to impulsivity and inattention rather than difficulty understanding
social cues.

6. Bipolar Disorder

 Similarities:
o Impulsivity and hyperactivity: During manic episodes, children with bipolar
disorder can exhibit behaviors similar to ADHD.
o Emotional dysregulation: Both conditions may involve rapid emotional shifts.
 Differences:
o Episodic vs. Pervasive: Bipolar symptoms fluctuate between manic and
depressive episodes, while ADHD symptoms are generally consistent across time.
o Mood-driven behavior: In bipolar disorder, hyperactivity and impulsivity are
driven by mood changes, while in ADHD, these are part of the core symptoms,
unrelated to mood states.

7. Sleep Disorders

 Similarities:
o Fatigue and inattention: Sleep disorders, such as sleep apnea or insomnia, can
lead to daytime fatigue, which affects focus and attention.
o Irritability and hyperactivity: Sleep-deprived children may become irritable and
overactive to stay awake, mimicking ADHD symptoms.
 Differences:
o The primary issue with sleep disorders is sleep disruption, whereas ADHD has
broader behavioral impacts.
o Addressing the sleep disorder can resolve the attention issues, unlike ADHD,
where treatment is ongoing.

8. Sensory Processing Disorder (SPD)

 Similarities:
o Hyperactivity and distractibility: Children with SPD may be overly sensitive to
environmental stimuli, leading to behaviors that mimic ADHD hyperactivity or
distractibility.
 Differences:
o In SPD, the child’s behaviors are directly related to sensory processing issues,
such as being overwhelmed by noise or touch. ADHD is not related to sensory
sensitivities but to attentional control and hyperactive behavior.

9. Intellectual Disability
  Similarities:
o Inattention and poor task completion: Children with intellectual disabilities (ID)
may appear inattentive and have trouble completing tasks due to their limited
cognitive capacities.
 Differences:
o Intellectual disabilities are marked by below-average intellectual functioning
and adaptive behavior, which is different from the attentional and hyperactive
symptoms of ADHD. Children with ID usually exhibit cognitive delays in various
areas that are not present in children with ADHD.

Steps in Differential Diagnosis of ADHD

1. Comprehensive Clinical Interview: Conduct a detailed interview with the child,

parents, and teachers to understand the full scope of symptoms and when they occur.
2. Behavioral Assessments: Utilize ADHD-specific tools like the Conners’ Rating Scales
or Vanderbilt ADHD Diagnostic Rating Scales, as well as other measures for anxiety,
depression, and autism.
3. Cognitive and Academic Testing: Use tools like the WISC-V or Woodcock-Johnson
to differentiate between ADHD and learning disabilities.
4. Observation in Multiple Settings: ADHD symptoms must be present across multiple
environments (e.g., home and school) to confirm the diagnosis. Other conditions may
only manifest in specific settings.
5. Medical Evaluation: Rule out any medical causes, such as sleep disorders or thyroid
problems, that may mimic ADHD symptoms.

How ADHD Affects Life

 At school: A child with ADHD may struggle to complete homework, stay focused in
class, or follow rules.
 With friends: They might act without thinking, which can cause misunderstandings or
conflicts.
 At home: ADHD can make it tough to stick to routines or stay organized.

Can ADHD be Managed?

Yes! With support, like special learning techniques, therapy, and sometimes medication, people
with ADHD can learn to manage their symptoms and do well in school, work, and relationships.
In short, ADHD makes it hard for people to focus, sit still, and think before acting, but with the
right help, they can thrive.

ADHD Case Examples and the 4P Model for Presentation (Simplified)

In your presentation, you can use the 4P model to organize ADHD case examples. The 4P model
stands for Predisposing, Precipitating, Perpetuating, and Protective factors. This approach
helps explain why a person might have ADHD, what makes it worse, and what could help
improve their condition.

Example 1: Sarah (13-year-old girl)

 Symptoms: Sarah struggles to focus in class, constantly daydreams, forgets homework,

and fidgets in her seat. She talks out of turn and has difficulty staying organized.

4P Model:

1. Predisposing factors (What puts her at risk):

o Family history of ADHD (Sarah’s father also had ADHD as a child).
o She was born prematurely, which is a known risk factor for ADHD.
2. Precipitating factors (What triggered the problem):
o Starting middle school with more complex assignments and less teacher support
made it harder for Sarah to keep up.
3. Perpetuating factors (What keeps the problem going):
o Lack of a structured daily routine at home (parents are busy, so Sarah forgets
tasks).
o Limited support from teachers who don’t understand her struggles with focus.
4. Protective factors (What helps improve the situation):
o Supportive parents who want to get her help.
o A close friend who helps remind her about homework and gives her emotional
support.

Example 2: Liam (9-year-old boy)

 Symptoms: Liam is very hyperactive, often running around the classroom. He interrupts
others, blurts out answers, and can’t sit still. At home, he gets into fights with his
siblings.

4P Model:

1. Predisposing factors:
 oLiam’s mother experienced high levels of stress during pregnancy, a risk factor
for ADHD.
o There is a family history of behavioral issues.
2. Precipitating factors:
o A new teacher who has strict rules makes it harder for Liam to adjust to the
classroom environment.
o His parents recently divorced, which increased stress in the family.
3. Perpetuating factors:
o Liam’s behaviors lead to conflicts with his peers and teachers, which make him
feel isolated.
o He hasn’t received any formal behavioral interventions or counseling.
4. Protective factors:
o He excels in sports and is very physically active, which helps him release energy.
o His grandmother provides emotional support and helps with his homework.

Example 3: Ava (15-year-old girl)

 Symptoms: Ava struggles with keeping track of time, is often late for school, forgets
about assignments, and gets overwhelmed easily. She feels frustrated because her grades
are dropping.

4P Model:

1. Predisposing factors:
o Ava has a history of anxiety and sleep problems, which can worsen ADHD
symptoms.
o Her mother reports similar issues with organization when she was younger.
2. Precipitating factors:
o Increased school workload in high school caused Ava to feel more overwhelmed,
leading to more noticeable ADHD symptoms.
3. Perpetuating factors:
o Ava's anxiety about school failure increases her difficulty concentrating.
o She avoids doing her homework because she’s afraid of not doing it well.
4. Protective factors:
o Ava is motivated to improve because she wants to get into a good college.
o Her school counselor is helping her with time management skills.

Summary for the Presentation

The 4P model can be used to:

 Predisposing: Identify what makes the person more likely to have ADHD.
  Precipitating: Explore what triggers ADHD symptoms.
 Perpetuating: Highlight factors that maintain or worsen the symptoms.
 Protective: Focus on what helps the person cope or improve.

This structure helps in understanding each ADHD case and in creating a clear plan for support.

Case 1: Michael (8-year-old boy)

Background:

Michael is in third grade. His teachers and parents have noticed that he’s always on the move,
has difficulty sitting still, and frequently disrupts the classroom.

Symptoms:

 Hyperactivity: Michael is constantly moving, running, and climbing, even when it’s not
appropriate.
 Impulsivity: He blurts out answers before the teacher finishes the question and interrupts
others during group activities.
 Inattention: Michael has a hard time following instructions, forgets his homework, and
often seems distracted during lessons.

Impact:

 At School: He often disrupts class by speaking out of turn and fidgeting in his seat. His
grades are below average because he has trouble focusing on his schoolwork.
 At Home: He doesn’t follow rules or routines, such as finishing his homework or sitting
at the dinner table.
 With Friends: His impulsivity makes it hard for him to get along with other children. He
struggles with waiting his turn in games and can sometimes act aggressively when
frustrated.

Diagnosis:

Michael likely has ADHD – Hyperactive/Impulsive type. His hyperactivity and impulsivity are
more prominent than his inattention, but all areas are impacted by his difficulty with self-
regulation.

Case 2: Emily (10-year-old girl)

Background:
Emily is a quiet 5th grader who often daydreams in class. Her parents were surprised when the
teacher brought up concerns about Emily’s focus and organization because she doesn’t have
behavioral problems.

Symptoms:

 Inattention: Emily often appears to be “zoning out” during class. She has difficulty
staying on task and frequently forgets to bring home her homework or turn it in on time.
 Disorganization: Her desk and backpack are messy, and she struggles to keep track of
her assignments and school supplies.
 Slow Processing: It takes Emily longer than her classmates to finish assignments, and
she often makes careless mistakes.

Impact:

 At School: Emily’s grades are suffering because she’s missing assignments and
struggling to complete tasks on time. Her teacher describes her as smart but
“disconnected” in the classroom.
 At Home: She often forgets to do her chores and gets easily distracted while doing them.
Her parents are frustrated because she doesn’t seem to be trying hard enough.
 With Friends: Emily is shy but has a few close friends. She tends to follow rather than
lead in social situations and sometimes gets left out because she’s slower to respond in
conversations.

Diagnosis:

Emily likely has ADHD – Inattentive type. Her main challenges revolve around focus,
organization, and completing tasks rather than hyperactivity or impulsivity.

Case 3: Sam (12-year-old boy)

Background:

Sam is a middle school student who has been struggling both academically and socially. His
teachers describe him as bright but unmotivated. He has difficulty focusing on his assignments
and often forgets to bring materials to class.

Symptoms:

 Inattention: Sam gets distracted easily in class, especially when the material doesn’t
interest him. He frequently forgets his homework and misses deadlines.
 Impulsivity: He acts before thinking, often interrupting teachers and classmates. In group
projects, he speaks over others and makes quick decisions without consulting the team.
  Emotional Outbursts: Sam becomes frustrated easily and has a short temper,
particularly when things don’t go his way or when he’s given challenging tasks.

Impact:

 At School: Sam’s grades are inconsistent. He does well on subjects that interest him, but
in other classes, he barely passes because he can’t stay focused or complete his
assignments. He often clashes with teachers due to his impulsive comments and behavior.
 At Home: His parents say he’s easily distracted, often leaving tasks half-finished. He
argues with them about chores and homework, and he gets upset when he doesn’t get his
way.
 With Friends: Sam has difficulty maintaining friendships. His impulsive behavior and
frustration with peers often lead to conflicts.

Diagnosis:

Sam likely has ADHD – Combined type. He exhibits symptoms of both inattention and
impulsivity, with emotional regulation challenges adding to his difficulties in school and social
settings.

Summary

 Michael has ADHD primarily with hyperactivity and impulsivity, leading to classroom
disruptions.
 Emily shows ADHD with inattention, affecting her academic performance and
organization.
 Sam displays combined ADHD symptoms, struggling with both focus and impulsive
behavior, along with emotional challenges.

These cases illustrate how ADHD can look different in each child, depending on which
symptoms are most prominent.