ADHD (vs. Bipolar or “Neuro”)

ADHD(vs. Bipolar or “Neuro”) Larry Fisher, Ph.D. UHS Neurobehavioral Systems

For More Information: • Larry Fisher, Ph.D. • UHS Neurobehavioral Systems • 12710 Research Blvd, Suite 320 • Austin, TX 78759 • 512-257-3468; fax 512-257-3478 • Email: • c n s g r o u p @ s w b e l l .n e t • www.ragebehavior.com

ADHD, Pediatric Bipolar, & “Neuro” Kids • ALL START IN CHILDHOOD • Attention Deficit Hyperactivity Disorder • ADHD starts before age seven • Pediatric Bipolar Disorder • Starts before puberty • Neurobehavioral Disorders • “Neuro” often prenatal or perinatal in origin • Initial symptoms start in early childhood

ADHD • First identified in1917 • pandemic of von Economo’s encephalitis • Called “Hyperkinesis” • Later renamed • “Minimal Brain Dysfunction” • Renamed again • “Attention Deficit Disorder (ADD) • Now: “ADHD” (Inattentive type, hyperactive impulsive type, combined)

ADHD • Affects 3-9 percent of school age kids • Symptoms persist into adulthood (40%) • ADHD kids spend less time immobile: • 66% less than normal kids • (Teicher, et al., 1996) • Hyperactivity is only apparent: • When ADHD kids are asked to sit still • Or during sleep (Porrino, et al., 1983)

ADHD • Symptoms must emerge before age 7 • Severe enough to cause impairments • Not due to other known mental disorder • Not due to PDD or Psychotic disorder • For at least six months: • At least six symptoms of inattention • Or six symptoms of hyperactive-impulsive • Or both (for combined type)

ADHD • ADHD kids are NOT more active in play • ONLY when asked to stop and sit still • Therefore, we see a diminished: • (1) ability to INHIBIT activity • Therefore: impulsive, hyperactive (immature) • (2) ability to INHIBIT response to distractions • Therefore: inattentive (not age appropriate) • The brain’s “brake” is not working well

Pediatric Bipolar Disorder • Bipolar (Manic Depressive) Disorder • Pediatric Mania (Geller et al., 2002) • Hyperactive even in play • ADHD normal during play • Racing thoughts, rapid speech • ADHD shows normal rate of cognition and speech • Little need to sleep • ADHD kids may be too hyper to fall asleep • But their need for sleep is otherwise normal • Euphoria, grandiosity - unique to Mania

ADHD versus Mania • ADHD = poor “brakes” • can’t stop - in age appropriate manner • Mania = too much “acceleration” • Brain is racing too fast • Both may show: • Hyperactivity, distractibility, irritability • Mania shows severe mood swings: • Elation, grandiosity, racing thoughts/speech

Irritable “Neuro” Kids • Irritability may be based on disorders of brain chemistry: • ADHD, Bipolar Disorder, Schizophrenia, etc. • Or it may be a “Neuro” kid with early brain damage from: • Drugs or alcohol used in pregnancy • Difficult or premature delivery • Very early traumatic brain injury • Genetic diseases • Brain electrical d/o’s

Impulsive/Irritable • Irritability = short fuse. • Early onset/persistent tantrums • Impulsive behavior • Impulsive aggression • These behaviors are NOT premeditated. • Irritable behaviors are not planned • Quick temper, hot temper, too much emotion • Differs from Conduct D/O, Psychopathy: • in cold blood, premeditated, too little emotion

Interventions • “GET TOUGH” approach does NOT work • Boot Camp is not effective, early relapse • Group therapy does not work either • Early interventions for at-risk kids work • For irritable/hyper kid, medication may work • Family support also effective • MST (Multi Systemic Therapy) • support parent & provide wrap-around • Identify psychiatric – ADHD or BIPOLAR • Identify brain disorders • Treat comorbid PTSD, Substance Abuse, etc.

ADHD & Life Impairments • Childhood • Academic and social issues • Adolescence • Substance abuse, driving accidents • Teen pregnancies, don’t finish school • Young Adults • Poor job stability, disrupted marriages • Financial difficulties, impulsive crimes

Other Psychiatric Disorders? • Disorders often comorbid with ADHD • Substance or Alcohol Abuse • Oppositional Defiant Disorder • Conduct Disorder • Mood Disorders (Bipolar or Depression) • Anxiety Disorders: • Obsessive Compulsive Disorder • Learning Disorders

Stimulants and others Methylphenidate-Ritalin Dextroamphetamine-Dexidrine Adderall Pemoline (Cylert) Amoxitine-Strattera (non-stim) Other: Wellbutrin, Clonidine

Treatment Types • Medications • Stimulants, Non-stimulants • Antidepressants, Alpha-2-Agonists • Parent Training – Positive Discipline • BIP (Behavior Intervention Plan) • Structure – routines, schedules • School supports (IEP)

Assessments • Comprehensive evaluation is best • Check for IQ, learning disabilities • Check for other diagnoses • Rule out Bipolar, “Neuro”, other • ADHD rating scales • Conners Scales for Teachers • Neuropsychological testing • Continuous Performance Test (CPT

Summary • ADHD • A common childhood disorder • With many causes • Often genetic (DAT-1, DRD2, D4 genes) • Can produce serious life distress • Learning, behavior, social, teen safety • Goal is resilience: • Positive discipline, structure, meds

ADHD (vs. Bipolar or “Neuro”)