AttentionDeficitHyperactivity Disorder ADHD

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Attention-Deficit Disorder/Attention-Deficit
Hyperactivity Disorder (ADD/ADHD)

• Harvey I. Payne, Psy.D
• Cynde Morgan, M.S.

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ADHD vs. ADD?

• What is the difference? The difference is mainly
  one of terminology. The official clinical
  diagnosis is Attention Deficit Hyperactivity
  Disorder, or ADHD of which there are three types.
  Many people use the term ADD as a generic term
  for all types of ADHD. The term ADD has gained
  popularity among the general public, in the
  media, and is even commonly used among
  professionals. Both terms basically refer to the
  same thing.

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History of ADHD

• Early 1900s- considered to be due to poor
  inhibitory volition and defective moral
  control
• Great encephalitis epidemic of 1917-1918 gave
  rise to the concept of a brain-injured child
  syndrome, often associated with mental
  retardation
• Concept evolved to minimal brain damage and
  minimal brain dysfunction in the 1940s and
  1950s

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History of ADHD (cont.)

• In 1950s- referred to as hyperkinetic impulse
  disorder motor overactivity seen as primary
  feature
• By 1970s, deficits in attention and impulse
  control, in addition to hyperactivity, seen as
  the primary symptoms
• Most recently, focus on problems in
  self-regulation and behavioral inhibition

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Appearance and Features of ADHD

• CORE FEATURES
• Attention problem attentional capacity,
  selective attention (distractibility), and/or
  sustained attention
• Overactivity restlessness, inability to sit
  still, fidgeting, constant movement

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Appearance and Features of ADHD

• CORE FEATURES
• Impulsivity interrupting others, difficulty
  waiting for turn, blurting out answers, making
  simple mistakes because of impulsive answers,
  acting without considering consequences

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DSM-IV Umbrella of Attention-Deficit/Hyperactivi
ty Disorders

• ADHD Combined Type
• ADHD Predominately Inattentive Type
• less common, slow processing speed, difficulties
  with information retrieval, anxiety/mood
  disorders
• ADHD Predominately Hyperactive/ Impulsive Type
• fidgets, leaves set unexpectedly, subjective
  feelings of restlessness, difficulty waiting
  turn, interrupts or intrudes on others

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Appearance and Features of ADHD

• CORE CRITERIA
• Onset prior to age 7
• Pervasive Behaviors in more than one setting
• No distinct physical signs identified through
  characteristic clusters of behavioral patterns
• Must be clear evidence of clinically significant
  impairment not due to another disorder

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Appearance and Features of ADHD

• COMMON FEATURES
• Poor school performance, learning disability
• Peer relationship problems
• Oppositionality/defiance or conduct problems

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Appearance and Features of ADHD

• COMMON FEATURES
• Able to attend to interesting, changing,
  reinforcing activities that are self-chosen
• Responsive to immediate, salient reinforcement
• Aggressive behavior

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Appearance and Features of ADHD

• Negative interactions/relationships with
  authorities
• Sleep disturbance
• Diagnosis prior to age 4 is less certain until
  the child enters school
• Physical problems, including higher injury risk
  and motor coordination problems

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Prevalence

• 3 - 5 of all school age children
• Diagnosed more frequently in boys (3 times more
  likely)
• Referral differences for girls versus boys
• DSM criteria may be more appropriate for boys
• Gender differences in community versus clinic
  samples
• Slightly more prevalent among lower SES groups
• Found in all countries and cultures, although
  rates vary

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ADHDAdolescent and Adult

• The statistical law of thirds
• 1/3 No symptoms at all
• 1/3 Essentially the same
• 1/3 External symptoms gone, internal symptoms
  remain

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The Lobes of the Brain

• The frontal lobes are involved in inhibiting or
  delaying motor response to stimuli. The right
  frontal lobe has been implicated as one potential
  site of pathologic neurotransmission in AD/HD.

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PET Scan of Adult with AD/HD

• Left, Normal Control Right, Patient with AD/HD.
  White, red, and orange indicate areas of
  relatively high glucose metabolism, whereas blue,
  green, and purple indicate areas of lower glucose
  metabolism. (The purple halo is an artifact.)
  (Zametkin AJ, Nordahl TE, Gros M, et al. Cerebral
  glucose metabolism in adults with hyperactivity
  of childhood onset. NEJM 1990 323(20)1361-6.)

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Causes of ADHDThe Common Behavioral Pathway
of Multidimensional Causes

• Genetic Basis
• Polygenic disorder, no single gene
• Mutations in genes that regulate the use of
  dopamine
• Maternal Tobacco Use
• High Levels of Lead
• Maternal Substance Abuse
• Fetal Alcohol Syndrome

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Causes of ADHDThe Common Behavioral Pathway
of Multidimensional Causes

• Premature Birth
• very low birth weight lt1500g, 3 lb 5 oz
• extremely low birth weight lt1000g, 2 lb 3oz
• 16 vs. 3-6 general population
• Meta-Analysis 2.64-fold increased relative risk
  of developing ADHD
• Maternal-Infant Attachment
• Regulation of affect, attention and behavior
• Dysregulation of affect, attention and behavior

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IMPLICATIONS FOR TREATMENT OF ADHD

• ADHD Is A Disorder Of Performance, Not Skill
• Time Is The Ultimate Disability
• Most Useful Treatments Are Those In Place In
  Natural Settings At The Point Of Performance,
  Where The Desired Behavior Is To Occur
• Treatment Is Symptomatic

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EVALUATION OF ADHD

• Developmental History And Clinical Interview
• Behavior Rating Scales
• Teacher/Parent/Self or Other/Self
• ADHD SPECIFIC Versus GENERAL
• Psychological Evaluation
• Confirmation Of The Diagnosis
• Alternative Diagnosis
• Comorbid Conditions

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Treatment of ADHD
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Treatment Options for ADHD Medications

• Stimulant medication is helpful for 60-80 of
  individuals with ADHD
• Non-Stimulant medication such as some
  anti-depressants also effective in some cases
• Medication is over all more effective for
  individuals without complicating psychological
  factors, especially long term medication

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Questions about Medications?
http//glennsacks.com/blog/?p940
Sacks Media Group, LLC.
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Behavioral Interventions Recommendations and
Accommodations

• Adolescent and Adult
• High School and College

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ADHD Recommendations and Accommodations

• Lacking in Executive Functioning
• May need to intersperse activity with study or
  classroom times
• Would benefit from
• accountability
• time management
• chunking
• list making

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ADHD Recommendations and Accommodations

• Affirm their strengths
• resilience
• boundless energy
• intuitive
• sensitive to the needs of others
• accepting and forgiving
• uninhibited
• risk takers
• inquisitive
• good imagination
• warm