ADHD THROUGH THE MOVIES www.adhdclinicjeeva.com

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ADHD THROUGH THE MOVIESwww.adhdclinicjeeva.com
DR SHABEER JEEVA CHILD AND ADULT PSYCHIATRIST
LRCP, LRCS(IRELAND), D.PSYCH(OTTAWA), F.R.C.P(CANA
DA)
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Patients with ADHD may suffer Because..

• Their parents dont understand them
• Their teachers cant stand them
• Their peers reject them
• Their spouses and bosses cant stand their
  disorganization and intensity
• They themselves begin to think no matter what I
  do I cant win

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Famous People with Attention Deficit and
Learning Disorders

• Albert Einstein
• Thomas Edison
• Gen. George Patton
• John F. Kennedy
• Bruce Jenner
• Eddie Rickenbacker
• Harry Belafonte
• Walt Disney
• Steve McQueen
• George C. Scott
• Tom Smothers
• Suzanne Somers
• Jules Verne
• Magic Johnson
• Carl Lewis

• Nelson Rockefeller
• Sylvester Stallone
• Cher
• Gen. Westmoreland
• Charles Schwab
• Danny Glover
• John Lennon
• Greg Louganis
• Winston Churchill
• Henry Ford
• Robert Kennedy
• George Bernard Shaw
• Beethoven
• Hans Christian Anderson

• Galileo
• Mozart
• Leonardo da Vinci
• Whoppi Goldberg
• Tom Cruise
• Henry Winkler
• F. Scott Fitzgerald
• Robin Williams
• Louis Pasteur
• Werner von Braun
• Dwight D. Eisenhower
• Lindsay Wagner
• Alexander Graham Bell
• Woodrow Wilson

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ADHD Diagnosis

• 5-9 children with this condition
• 60 of these children go on to adulthood with
  impairing symptoms
• Core symptoms are
• Impulsivity
• Attentional problems
• Motor hyperactivity

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Visual Images

• Move in the academic teaching arena to use movies
  and visual processes as ways of teaching
• ADHD patients respond better to visual systems
  rather than talking
• Auditory processing problems
• Strengths in visual-spatial ability
• Ability to see the forest but not the trees

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Impulsivity

• An urge that is difficult to resist
• Dennis the Menace
• The Simpsons

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Dennis the Menace
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Inattention

• Loss of order and loss of presence of mind
• Home Alone
• Inspector Gadget
• Gilligans Island
• Get Smart

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Home Alone 2
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Motor Hyperactivity

• Any movie by
• Jim Carrey
• Robin Williams
• Howie Mandell
• Tom Cruise

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ADHD-Developmental

• You must accept that if ADHD is a lifelong
  disorder, then your personality must change. The
  Adult is still having power battles with
  authority figures which is similar to the power
  battles within themselves.
• Different Examples
• -Officer and a Gentleman
• -Goodwill Hunting
• -The Lion King
• -Mrs. Doubtfire

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Good Will Hunting
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ATTENTION DEFICIT DISORDER

• A.D..D.
• IMPULSIVITY
• Failure to think of
• Consequences before
• acting
• --------------------------------------------------
  ------------------------------------------------
• Combined

• ATTENTION
• DISTRACTIBILITY
• Trouble holding focus
• A.D.H.D.
• OVERACTIVITY
• (easily bored/excess energy.)

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Symptoms of Hyperactivity Often Manifest
Differently in Adults
Hyperactivity often changes to inner restlessness

• Common Adult Manifestation
• Workaholic
• Overscheduled/overwhelmed
• Self-selects a very active job
• Constant activity leading to family tension
• Talks excessively

• DSM-IV Symptom Domain
• Squirms and fidgets
• Cant stay seated
• Runs/climbs excessively
• Cant play/work quietly
• On the go/driven by motor
• Talks excessively

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Symptoms of Inattention Often Manifest
Differently in Adults

• DSM-IV Symptom Domain
• Difficulty sustaining attention
• Doesnt listen
• No follow-through
• Cant organize
• Loses important things
• Easily distractible, forgetful

• Common Adult Manifestation
• Difficulty sustaining attention
• Meetings, reading, paperwork
• Paralyzing procrastination
• Slow, inefficient
• Poor time management
• Disorganized

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Symptoms of Impulsivity Often Manifest
Differently in Adults
Impulsivity in adulthood often carries more
serious consequences

• DSM-IV Symptom Domain
• Blurts out answers
• Cant wait turn
• Intrudes/interrupts others

• Common Adult Manifestation
• Low frustration tolerance
• Losing temper
• Quitting jobs
• Ending relationships
• Driving too fast
• Addictive personality

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ADHD Impairment Persists
Adulthood
Childhood
? ? ?
Job failure or underemployment
School failure or underachievement
Fatal car wrecks or risk taking
Multiple injuries
Drug dependence
Drug experimentation
Antisocial personality disorder, criminality
Oppositional defiant or conduct disorder
Unwanted pregnancy, sexually transmitted
disease, etc
Impulsivity, carelessness
Hopelessness, frustration, giving up
Repetitive failure
Courtesy of W. Dodson, MD
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Diagnosis of ADHD in AdultsCommon Clinical
Histories

• Difficulties in Elementary or Secondary School
• Comments not living up to potential, spacey,
  hyper
• Behavioral issues class clown
• Difficulties in College
• Incomplete degree or longer time to complete
  degree
• Difficulty engaging in further education
• Difficulties at Work
• Underachievement (mixed reviews)
• Low efficiency 4 times longer to complete tasks
• Difficulties at Home
• Poor organization, does not complete tasks
• Strained relationships with spouse and kids(who
  also may have ADHD)

Courtesy of T. Wilens, MD
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Sound of Music
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Office Presentation

• Patients with ADULT ADHD

• Are forgetful or airheads
• Miss appointments or arrive late
• Lose prescriptions
• Do not carry out instructions or the treatment
  plan
• Are hypertalkative
• Are passionate or have emotional storms
  triggered by events

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ADHD and Comorbid Conditions
Impulsivity/ Hyperactivity
Inattention
Comorbidity
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Clinical Presentation

• Multiple mental health consultations
• Multiple jobs
• Stormy relationships
• Trouble with authority figuresarrest record
• Family history of bipolar disorder,substance
  abuse, or Tourette syndrome
• Family history of ADHD
• Performance and mood determinedby interest and
  challenge

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Comorbid Psychiatric Disturbances Are Common in
Adults With ADHD
Antisocial Disorder (10) Major Depressive
Disorder (35) Bipolar Disorder (15) Anxiety
Disorders (40) Substance Abuse Disorders (50)
Shekim WO et al. Compr Psychiatry.
199031416-425. Biederman J et al. Am J
Psychiatry. 19931501792-1798.
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Officer and A Gentlemen
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ADHD Comorbidity in Adults with Other
Psychiatric Disorders
Disorder ADHD
Rate Major Depression1
20 Bipolar Disorder2 15 Generalized
Anxiety Disorders3 20 Substance Abuse4
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Re-evaluate refractory patients for ADHD
1. Alpert et al. Psychiatry Res. 1996. 2.
Nierenberg et al. APA Presentation. 2002. 3.
Fones et al., J Affective Dis 2000 4. Wilens.
Psych Clin N Am 2003.
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Domains of Impairment
Health/Injury
Academic/ Occupational
Impairments
Substance Abuse
Self-esteem
Sexual Behavior
Social Functioning
Criminality
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Mrs. Doubtfire
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ADHD Owners Manual

• Many people with ADHD dont realize they have an
  owner's manual. We help them to learn about
  themselves. This is the way you are.
• ---How to maximize your strengths and minimize
  your weaknesses.
• It helps people look at themselves in a more
  positive way and to learn why things have
  happened.

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Potential Areas of Impairment
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Sound of Music
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Pharmacotherapy in Adults

• Stimulants
• Methylphenidate-Ritalin
• Amphetamine compounds-Dexedrine
• Magnesium pemoline (not recommended)
• Long acting stimulants -Ritalin-SR.Ritalin-L.A,Con
  certa,Adderal XR
• Atomoxetine (FDA-approved in adults)-Straterra
• Antidepressants
• Bupropion-Welbutrin SR
• SSRI/SNRI
• Tricyclics
• Other
• - Mood Stabilizers Valproic Acid/Lithium
• - Atypical Antipsychotics Resperidone
• - Clonidine
• Research
• Modafinil

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ATTENTION DEFICIT DISORDEREffects of Medication

• IMPROVES
• Compliance
• Following the rules
• Percentage of seat work completed
• Accuracy of seat work
• Teachers rating of behaviour
• Performance on cognitive laboratory tasks
• Handwriting
• Central auditory processing testing
• Positive attention from mothers

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ATTENTION DEFICIT DISORDEREffects of Medication

• DECREASES
• Fidgeting
• Impulsivity
• Negative social behaviours
• Vocalizations and noise
• Controlling behaviour of mothers and teachers
• Intensity of interactions by teachers
• Off-task behaviour in class

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ADHD, ODD and CD Integrative Interventions

• Preventative interventions (i.e. preventing the
  development of comorbid disorders)
• Patient, parent, spouse training and support
• Individual counseling and therapy
• Group counseling and therapy
• Family counseling and therapy
• Interventions at school and work place
• Medication eg. Resperidone
• Working with correctional systems

Turgay (2001), The World of Children 4, Winter
2001 pp9-28
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Lion King
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Conclusions

• ADHD symptoms are impairing
• The symptoms continue into adulthood
• Early problems of attachment lead to a false
  sense of self
• Insight to the clinical symptoms has profound
  implication to treatment and compliance

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?ADULT ADHD SYMPTOMS