Attention Deficit Hyperactivity Disorder

1. Attention Deficit Hyperactivity Disorder Carolyn R. Fallahi, Ph. D.

2. Introduction • Case Studies in ADHD. • Symptom presentation. • History of ADHD • Nursery rhyme presented in your book by Henrich Hoffman, a German psychiatrist, (mid 1800s). • Phil, stop acting like a worm; The table is no place to squirm; Thus speaks the father to his son. Severely says it, not in fun. Mother frowns and looks around; Although she doesn’t make a sound; But Phillip will not advise; He’ll have his way at any price; He turns; And churns; He wiggles; And jiggles; Here and there on the chair; Phil, these twists I cannot bear.

3. History • 1902: George Still (Royal College of Physicians): restlessness, inattentiveness, and overarousal in children. • 20th Century: encephalitis lethargica – epidemic in America and Europe. Led to the idea that ADHD was neurologically based. Postencephalitic Behavior Disorder. • Minimal Brain Dysfunction. • Hyperkinetic Impulse disorder (DSM II diagnosis). • Attention Deficit Disorder (DSM III diagnosis). • Attention Deficit Hyperactivity Disorder (ADHD; DSM-IIIR 1987).

4. ATTENTION-DEFICIT/HYPERACTIVITY A. Either (1) or (2): (1) 6 or more of following have persisted for 6 months to degree that is maladaptive and inconsistent with developmental level: Inattention ____ ____ often fails to pay attention to details or makes careless mistakes in school or other activities ____ ____ often has difficulty sustaining attention ____ ____ often does not seem to listen when spoken to directly ____ ____ often doesn't follow through on instructions and fails to finish things ____ ____ often has difficulty organizing tasks and activities ____ ____ often reluctant to do things requiring sustained mental effort ____ ____ often loses things ____ ____ easily distracted ____ ____ often forgetful

5. 2) 6 or more of following have persisted for 6 months to degree that is maladaptive and inconsistent with developmental level: Hyperactivity ____ ____ often fidgets with hands or feet or squirms in seat ____ ____ often leaves seat in class ____ ____ often runs or climbs excessively in inappropriate situations ____ ____ often has difficulty playing quietly ____ ____ often "on the go" or acts as if "driven by a motor" ____ ____ often talks excessively Impulsivity ____ ____ often blurts out answers before question completed ____ ____ often has difficulty awaiting turn ____ ____ often interrupts or intrudes on others B. ____ ____ Some symptoms present before age 7 C. ____ ____ Some impairment present in 2 or more settings D. ____ ____ Symptoms do not occur exclusively during Pervasive Developmental Disorder, Schizophrenia, are not better accounted for by depression or anxiety

6. Subtypes of ADHD • Attention Deficit Hyperactivity Disorder – Predominantly Inattentive Type • Attention Deficit Hyperactivity Disorder – Predominantly Hyperactive-Impulsive Type • Attention Deficit Hyperactivity Disorder – Combined • New subtype: Sluggish Cognitive Tempo

7. Controversies and Unresolved Issues • The issue involving the diagnosis of ADHD, inattentive type. • What is normal versus clinical? • ADHD diagnosis and age.

8. Epidemiology • Prevalence: 3-5% children; 2-3% adolescents. • Cultural issues? • Gender differences: seen more in boys 6-9x. • Co-occurring disorders: • Conduct disorder • Depression. • Bipolar Disorder. • Anxiety Disorders. • Learning disorders

9. Co-morbidity

10. Additional problems for patients with ADHD • Intelligence and academics • Problems with family and peer relationships • Emotional dysregulation • Sleep and health problems

11. Developmental course of ADHD • Problems across the lifespan

12. Etiology of ADHD • Genetic explanations • Neurological explanations • Structural problems within the brain • Neurotransmitters • Prenatal explanations • Social explanations

13. Treatments for ADHD

14. Stimulants and ADHD • Mechanism of action • Common Stimulants used to treat ADHD