Gap Analysis/ADHD: Difference between revisions
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== Their challenges == | == Their challenges == | ||
* | Challenges for people with ADHD are dependent on their presentation of ADHD and the symptoms associated with the individual. Due to the high incidence of comorbidity with learning disabilities, it is difficult to identify challenges that are unique to people with ADHD. As noted above, the number and severity of the symptoms associated with a particular presentation of ADHD can vary with time (Centers for Disease Control and Prevention, 2014a). A result of this is that the challenges for a person with ADHD can also vary in type and intensity as the individual ages. | ||
* | In general terms, the challenges associated with ADHD highlighted by Nigg (2009)include: | ||
* | * '''Issues with speed and attention to detail:''' Tasks are often completed with excessive speed (Hyperactivity-impulsivity) or excessively slowly due to lack of interest (Inattentive). In both cases these behaviors are associated with inaccuracy. | ||
* '''Issues with Rapid decision making:''' The ability to interrupt their responses often results in answers being blurted out and talking out of turn during meetings. | |||
* '''Executive Functioning and Working Memory:''' The inability to follow instructions to their conclusion is common, especially when the instructions are presented in list form. This challenge can also extend to tasks that involve ordered steps such as complex arithmetical operations or equation solving. Issues with working memory are often exhibited as forgetfulness. | |||
* | * '''Social Issues:''' In addition to difficulty interpreting social subtexts, momentary lapses in attention is common. This can often result in missing important details if they are not repeated. Children with ADHD often have difficulty estimating the value of social contact, consistently underrating the rewards associated with social contact when compared to control groups (Demurie, et al., 2011). | ||
* '''Self-worth Issues:''' Anecdotal evidence form teachers and parents suggest that children with ADHD exhibit low self-esteem and lack of confidence. This may be a result of peer rejection due to actions by a person with ADHD being considered inappropriate. Self-worth issues can result in tasks being abandoned earlier than would be the case with a control group and a perceived lack of commitment to group and/or team activities. | |||
== Some persona with use case that address key challenges == | == Some persona with use case that address key challenges == | ||
Revision as of 14:18, 23 September 2014
Description
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder affecting both children and adults. It is characterized by some persistent (lasting at least 6 months) symptoms of hyperactivity, impulsivity, and/or inattention that significantly impacts on daily life or typical development. The symptoms frequently occur in more than one environment (e.g. in work and at home) and they must not be appropriate for the age of the individual. The symptoms should also cause social, educational or work related issues (American Psychiatric Association, 2013).
Review of the available literature suggest that ADHD is not viewed as single impairment / disease entity, but people with ADHD can be considered as a heterogeneous group of individuals defined by a series of behavioural symptoms. The symptoms presented vary in type and intensity between individuals with ADHD and may vary in type and intensity with time for a given individual.
Cognitive functions
No single cognitive impairment characterises people with ADHD (American Psychiatric Association, 2013). Cognitive impairments, although secondary, feature in the diagnosis of ADHD (American Psychiatric Association, 2013)and are vital in determining the learning and cognitive needs of people with ADHD.
Studies have suggested that children with ADHD exhibit multiple deficits in working memory related to spatial storage and spatial executive functioning that are independent of any language learning disorders presented by the same individual (Martinussen, et al., 2005). It has also been suggested that dysfunctional neurological parallel processing pathways are a potential partial explanation of executive dysfunction association with ADHD, but further research on cognition form a neurophysiological and developmental point of view are required to confirm this (Castellanos, et al., 2006).
Cognitive impairments associated with ADHD include (Nigg, 2009):
- Issues with executive functioning
- Reading learning disabilities
- Maths disabilities
- Handwriting disabilities
- Non-verbal learning disabilities
- Diminished visual processing speeds not related to inattention (Weiler, et al., 2002)
- Developmental coordination disorder / motor clumsiness. Motor clumsiness may be less prevalent in older children (9 years and older), teenagers and adults with ADHD (Meyer & Sagvolden, 2006)
Context dependent cognitive effects associated with ADHA include issues with (Nigg, 2009):
- Slow careful behavior
- Fast accurate behavior
- Rapid decision making
- Planning and short term recall
- Reward cues
- Time estimation
It is unclear if any of these context dependent cognitive effects are unique to ADHD. However, evidence suggests they are not explained by co-occurring problems and, in most instances, they are more clearly associated with ADHD (the issue being more pronounced) than with other disorders exhibiting the same issue (Willcutt, et al., 2008).
Comorbidity with learning disabilities is common in people with ADHD. The literature reviewed shows a wide variance of the incidence of people with ADHD that also present with learning disabilities of between 20 and 60% (Czamara, et al., 2013). This highly variable overlap has been previously attributed to inconsistencies in the definition of learning disabilities and a general over identification of learning disabilities (Semrud-Clikeman, et al., 1992). However, comorbidity with reading disorder (Germanò, et al., 2010), dyslexia and dyspraxia (Pauc, 2005) and dyscalculia (Lindsay, et al., 2001)have all been reported, although the underlying functional processes remain unclear (Czamara, et al., 2013).
Comorbidity with behavioral disabilities (such as oppositional defiant disorder and developmental coordination disorder) has been shown to be extremely high (>70%) amongst young children (Kadesjö & Gillberg, 2001) suggesting that ADHD without comorbidity is atypical in children with ADHD.
Symptoms
The most commonly used diagnosis of ADHD follows the guidelines outlined by the American Psychiatric Association (2013) and will be followed here. Three presentations (formerly called subtypes) of ADHD are recognised:
- Predominantly Inattentive ADHD
- Predominantly Hyperactive-Impulsive ADHD
- Combined ADHD
Predominantly Inattentive ADHD - symptoms
Symptoms associated with Predominantly Inattentive ADHD include:
- Failing to pay close attention to detail or making careless mistakes
- Having difficulty sustaining attention
- Not appearing to listen
- Struggling to follow instructions to completion
- Difficulty with organization
- Avoiding or disliking tasks requiring a lot of thinking
- Losing things
- Being easily distracted
- Being forgetful in daily activities
Predominantly Hyperactive-Impulsive ADHD – symptoms
Symptoms associated with Predominantly Hyperactive-Impulsive ADHD include:
- Fidgeting with hands or feet or squirming in chairs
- Having difficulty remaining seated
- Running around or climbing excessively in children; extreme restlessness in adults
- Difficulty engaging in activities quietly
- Acting as if driven by a motor; adults will often feel inside like they were driven by a motor
- Talking excessively
- Calling out answers before questions have been completed
- Difficulty in waiting or in taking turns
- Interrupting or intruding upon others
Diagnosis of ADHA
To be diagnosed with ADHD using the above symptoms, a child should exhibit at least 6 of the symptoms of the disorder and late teens and adults at least 5 symptoms. The ADHD presentation exhibited depends on the predominance of the symptoms being mostly inattentive symptoms, mostly hyperactive-impulsive symptoms or a relatively equal mix of symptom type resulting in Predominantly Inattentive ADHD, Predominantly Hyperactive-Impulsive ADHD or Combined ADHD respectively.
ADHD presentations can be subdivided into mild, moderate or severe depending on both the number of symptoms exhibited and the impact the symptoms have on the individual’s daily life. Presentations are not fixed and can change throughout the life time of a person with ADHD as can the severity of the individual symptoms.
Their challenges
Challenges for people with ADHD are dependent on their presentation of ADHD and the symptoms associated with the individual. Due to the high incidence of comorbidity with learning disabilities, it is difficult to identify challenges that are unique to people with ADHD. As noted above, the number and severity of the symptoms associated with a particular presentation of ADHD can vary with time (Centers for Disease Control and Prevention, 2014a). A result of this is that the challenges for a person with ADHD can also vary in type and intensity as the individual ages. In general terms, the challenges associated with ADHD highlighted by Nigg (2009)include:
- Issues with speed and attention to detail: Tasks are often completed with excessive speed (Hyperactivity-impulsivity) or excessively slowly due to lack of interest (Inattentive). In both cases these behaviors are associated with inaccuracy.
- Issues with Rapid decision making: The ability to interrupt their responses often results in answers being blurted out and talking out of turn during meetings.
- Executive Functioning and Working Memory: The inability to follow instructions to their conclusion is common, especially when the instructions are presented in list form. This challenge can also extend to tasks that involve ordered steps such as complex arithmetical operations or equation solving. Issues with working memory are often exhibited as forgetfulness.
- Social Issues: In addition to difficulty interpreting social subtexts, momentary lapses in attention is common. This can often result in missing important details if they are not repeated. Children with ADHD often have difficulty estimating the value of social contact, consistently underrating the rewards associated with social contact when compared to control groups (Demurie, et al., 2011).
- Self-worth Issues: Anecdotal evidence form teachers and parents suggest that children with ADHD exhibit low self-esteem and lack of confidence. This may be a result of peer rejection due to actions by a person with ADHD being considered inappropriate. Self-worth issues can result in tasks being abandoned earlier than would be the case with a control group and a perceived lack of commitment to group and/or team activities.
Some persona with use case that address key challenges
To do: Add persona and scenario
To do: Add table of ICT Steps and challenges.
| Step | Challenge | |
|---|---|---|
How they use the web and ICT to include: Email, apps, voice systems, IM
apps such as Timers and To-Do Lists to remind them of activities Email to send items to themselves as reminders for follow-up VM - Same as email, send a voice mail as a reminder.
How people with cognitive disabilities use optimized content and special pages
To do: Add examples with descriptions of features
Characteristics of content optimized for this group
To do: Add descriptions of key features and how it helps users overcome challenges
Specific technologies (reference section bellow and how they use it differently)
Many resources/experts suggest using a smartphone with a calendar and to-do list. These can also be used as timers and alarms for limiting time on tasks (work, homework, TV, internet, reading) and can also be used as an alarm system to time leaving for school or work - not just for getting out of bed.
The editors of HealthLine curated a list of the 16 best ADHD apps at http://www.healthline.com/health-slideshow/top-adhd-android-iphone-apps#1
Summary Existing research and guidelines
To do: Add literary summary and insert guidelines and or references
Extent to which current needs are met
To do: Review challenges and describe where needs are met. Identify gaps
Potentials and possibilities
To do: Add ideas for filling gaps
Prevalence
To do: Add section
Percent of Youth Aged 4-17 with Current Attention-Deficit/Hyperactivity Disorder by State: National Survey of Children's Health - US 8.8 (3)
References to research.
LD/ADHD stuff: http://www.catea.gatech.edu/scitrain/science/modules/adhd/introduction.php http://www.catea.gatech.edu/scitrain/science/modules/ld/module8_1.php
References:
# 1) https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=4&cad=rja&uact=8&ved=0CEYQFjAD&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fbooks%2FNBK64203%2F&ei=mB9IU7iwE-ez8AH6mYDABw&usg=AFQjCNFy7w32udum9OGTHqToONoYaaq9NQ&sig2=YatAY4Cy9qynVmgMoLuDSA&bvm=bv.64542518,d.b2U # 2) http://pediatrics.aappublications.org/content/early/2011/10/14/peds.2011-2654.full.pdf # 3) http://www.cdc.gov/ncbddd/adhd/prevalence.html # 4) http://www.additudemag.com/ - Attention Deficit Disorder on-line magazine # 5)