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Dept of Children & Families / NJ Task Force on Child Abuse & Neglect Presentation

 

 

 

 

October 21, 2011: East Brunswick NJ

The Department of Children and Families and the New Jersey Task Force on Child Abuse and Neglect  had a  statewide child maltreatment prevention conference today and I had great fun doing today’s presentation:

Differential Diagnosis of Inattention, Hyperactivity and Impulsivity in At-Risk Children” with our clinical team, Alla Gordina, MD, FAAP and Lydia Shifrin, LCSW.

We had a terrific crowd, who asked great questions and gave excellent feedback.

Presentation Highlights:

Attention Deficit/Hyperactivity Disorder is one of the most common and  the most controversial neurobehavioral disorders in children diagnosed today

Core symptoms of ADHD include  Inattention, Impulsivity and Hyperactivity

Some ADHD statistics:

  • Approximately 9.5% or 5.4 million children 4-17 years of age have ever been diagnosed with ADHD, as of 2007.
  • The percentage of children with a parent-reported ADHD diagnosis increased by 22% between 2003 and 2007.
  • Rates of ADHD diagnosis increased an average of 3% per year from 1997 to 2006 and an average of 5.5% per year from 2003 to 2007.
  • Boys (13.2%) were more likely than girls (5.6%) to have ever been diagnosed with ADHD.
  • The highest rates of parent-reported ADHD diagnosis were noted among children covered by Medicaid and multiracial children.

However,  numerous medical, psychiatric, neurological, psychological, speech-language and other disorders are frequently misdiagnosed as ADHD

NEARLY 1 MILLION CHILDREN ARE MISDIAGNOSED WITH ADHD

“Since ADHD is an underlying neurological problem where incidence rates should not change dramatically from one birth date to the next, these results suggest that age relative to peers in class, and the resulting differences in behavior, directly affects a child’s probability of being diagnosed with and treated for ADHD.”  (Elder, 2010). Journal of Health Economics

 

Disorders frequently misdiagnosed as AD/HD :

  • Respiratory Disorders (e.g., adenoid hypertrophy, asthma, allergic rhinitis)
  • Metabolic /Endocrine Disorders (e.g.,  diabetes, hypo/hyperthyroidism)
  • Hematological Disorders  (e.g., anemia)
  • Immunological Disorders (acquired and congenital immune problems)
  • Cardiac Disorders (e.g., congenital and acquired heart disease, syncopy)
  • Digestive  Disorders (e.g., irritable bowel syndrome, GERD, etc)
  • Neurological Disorders  (e.g., Traumatic Brain Injuries, Tumors, Encephalopathy, etc)
  • Sleep Disorders
  • Genetic Disorders (e.g., FASD, Fragile X Syndrome)
  • Toxin Exposure (e.g., Lead, Mercury, Drug Exposure)
  • Infections and Infestations (e.g., yeast overgrowth , intestinal worms/parasites)
  • Mental Health Disorders (e.g., anxiety, mood disorders, adjustment disorders)
  • Mental Retardation
  • Sensory Processing Disorders (vision, hearing, auditory, tactile)
  • Language Processing Disorders
  • Auditory processing Disorders

My presentation focused on explaining that having select language based difficulties can cause the child to act as inattentive, hyperactive and impulsive without actually having ADHD

My examples included:

  • Traumatic Brain Injury
  • Severe Language Delay
  • Auditory Processing Disorders
  • Social Pragmatic Language Deficits

Relevance and Implications for Adoption Professionals:

  • Multidisciplinary approach to identification, differential diagnosis, and management of disorders with “AD/HD” symptoms is NEEDED
  • One individual assessment (e.g.,  psychological) CANNOT reliably determine accurate diagnosis, especially when the diagnostic criteria is based on generalized symptomology
  • Refer adopted children with behavioral, listening, sensory, and any unusual deficits for multidisciplinary assessments which include in depth assessment of language abilities before making a conclusive diagnosis
  • Children who receive one assessment ONLY are at risk of misdiagnosis, misidentification, and are delayed in getting appropriate intervention services
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AAP: Council on Foster Care, Adoption and Kinship Care Presentation

Boston MA- First conference of the Fall 2011 season:

October 17, 2011: Got to co-present with my favorite pediatrician (Alla Gordina, MD, FAAP) an interesting clinical case in front of American Academy Of Pediatrics: Council on Foster Care, Adoption and Kinship Care. Granted my part was via phone and connection wasn’t great but it so nice to see medical professionals being interested in ancillary professionals’ perspective on issues of internationally adopted children.

Presentation Title: A Case of Isolated Social Pragmatic Language Deficits in an Internationally Adopted Child

Presentation Highlights:

Language based deficits may affect internationally adopted children many years post adoption

Even children adopted at very young ages can present with subtle BUT significant delays in select areas of functioning (see below)

One such delay may be in the area of social pragmatic functioning  or the use of language

Select examples of social pragmatic deficits include:

  • Impaired ability to appropriately interpret social situations, events and contexts
  • Impaired ability to create and convey messages to different audiences (adults vs. children)
  • Impaired ability to interpret facial expressions, body language and gestures
  • Difficulty labeling and identifying basic emotions of self and others
  • Poor or absent perspective taking (understanding thoughts and feelings of others)
  • Inappropriate initiation of social interactions (e.g., not knowing how to start a conversation or appropriately interrupt a game)
  • Comprehension of age-level abstract and inferential information (stories, sarcasm, figurative language, etc)
  • Missing “the big picture” (integrating ideas into a whole, synthesizing and summarizing information)
  • Poor connection and relatedness to peers

Implications for Professionals:

Very easy to misdiagnose a child with social pragmatic deficits as someone with psychiatric disturbances (e.g., ADHD or Autism) without multidisciplinary differential diagnosis

“Low risk referrals” do carry a significant risk of deprivation-related issues, which can surface years after adoption

Internationally adopted children with behavioral, listening, sensory, and any unusual deficits need a differential  diagnosis (including assessment of language abilities before a conclusive diagnosis is made)