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What is ADHD?
What is ADHD?
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Prepared by Harvey C. Parker, Ph.D.
www.myADHD.com
Copyright © 2004 All rights reserved.
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Disclaimer
These slides and the accompanying presentation
provide a general overview of strategies to
manage attention-deficit/hyperactivity
disorder
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(ADHD) and related conditions and do not
constitute medical, psychological, educational, or
legal advice. Please consult your own health care
provider or other professional for specific advice.
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Finding Answers for ADHD
• What is ADHD?
• How does ADHD affect daily living?
• What causes ADHD?
• What procedures are used to assess ADHD?
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• What treatments
• How can assessment tools, tracking tools, and
treatment tools from myADHD.com help families,
practitioners, educators, and adults?
• How can teachers and parents help?
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What is ADHD?
• …A medical condition characterized by
inattention and/or hyperactivity-impulsivity.
• …One of the most common mental disorders
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among children, affecting approximately 5 to
7 % of school-age children and about 2-5%
of adults
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Prevalence in the United States
About 2 million children
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About 5 million adults
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Prevalence World Wide
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Canada
Australia
New Zealand
Germany
India Click to
China
Netherlands
Puerto Rico
Japan
Mexico
Brazil
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3.8-9.4% kids
3.4% of kids
6.7% kids, 2-3% teens
4.2% children
5-29% children
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6-9% children
1.3% teens
9.5% child & teens
7.7% children
approx. 5% children
5.8% of 12-14 year olds
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Adult ADHD Remains Largely
Undiagnosed*
15% Diagnosed
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85% Undiagnosed as an Adult
*1999 analysis of a 1000 adult patient epidemiological database.
Data on file, Lilly Research Laboratories.
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Three types of ADHD
1. ADHD, predominantly inattentive type
2. ADHD, predominantly hyperactive-impulsive
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3. ADHD, combined type
ADHD, NOS is a category for people who have some ADHD
symptoms, but not enough to meet full criteria for the condition.
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DSM-IV Criteria:
6 of 9 Inattention Symptoms
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Fails to give close attention to details
Difficulty sustaining attention
Does not seem to listen
Does not follow through on instructions
Difficulty Click
organizing
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or activities
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Avoids tasks requiring sustained mental effort
Loses things necessary for tasks
Easily distracted
Forgetful in daily activities
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DSM-IV Criteria:
6 of 9 Hyperactive-Impulsive
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Fidgets with hands or feet or squirms in seat
Leaves seat in classroom inappropriately
Runs about or climbs excessively
Has difficulty playing quietly
Is “on theClick
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Talks excessively
Blurts out answers before questions are completed
Has difficulty awaiting turn
Interrupts or intrudes on others
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Other DSM-IV Criteria
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Developmentally Inappropriate Levels
Duration of 6 Months
Cross-setting Occurrence of Symptoms
Impairment in Major Life Activities
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Onset ofClick
Symptoms/Impairment
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Exclusions: Severe MR, PDD, Psychosis
Subtyping into Inattentive, Hyperactive, or
Combined Types
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ADHD is Not a Problem of:
• Will power
• Inadequate parenting
• Lack of motivation
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• Lack of Click
intelligence
• Laziness
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ADHD is Not a Problem of:
• Will power
• Inadequate parenting
• Lack of motivation
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• Lack of Click
intelligence
• Laziness
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ADHD is a neurological disorder
that impairs
• Regulation of attention
• Regulation of motor activity
• Regulation of impulsivity
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ADHD results in problems with
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Planning
Organizing
Starting and stopping activity
Managing behavior
Persisting
on tasks
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Problem solving
Working memory
These are called Executive Functions
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AAP Assessment Guidelines
• Diagnosis must meet DSM IV criteria
• Evidence of symptoms and impairment must come
from parents or caregivers
• Evidence of symptoms and impairment must come from
classroom teacher or other school professional
• AssessmentClick
shouldto
include
for co-morbid
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• Rating scales designed specifically to assess ADHD symptoms
should be used in addition to narrative reports, observations,
etc.
• Other diagnostic tests are not routinely used to establish
presence of ADHD but may be used to discover other
conditions
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Potential Areas of Impairment
Occupational/vocational
Motor vehicle accidents
Injuries
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Smoking and SUD
Legal difficulties
Relationships
Academic failure
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ADHD has a Neurobiological
Basis
• Dysfunction of
dopaminergic and
noradrenergic systems
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• Dopamine
norepinephrine are
important in drugs that treat
ADHD
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Arnsten AF. J Psychopharmacol 1997;11:151-62; Madras BK, et al. Behav Brain Res 2002;130:57-63; Russell
VA. Behav Brain Res 2002;130:191-6; Solanto MV. Behav Brain Res 2002;130:65-71.
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How do you get ADHD?
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ADHD Is highly heritable
Depression
IQ
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Schizophrenia
ADHD
Height
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0.2
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0.6
0.8
Heritability
estimate
Heritability
Estimate
Faraone SV, et al. Child Adolesc Psychiatr Clin N Am 2001;10:299-316, viii-ix; Faraone SV, et al. Am J
Psychiatry 2001;158:1052-7; MARK Web site.
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Common Comorbid Diagnoses
0
10
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Oppositional
defiant disorder
Conduct
disorder
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Mood disorder
Anxiety
disorder
Learning
disorder
Biederman et al. JAACAP 1996;35:343.
Biederman et al. JAACAP 1999;38:966.
Pliszka. J Clin Psychiatry 1998:59(suppl 7):50.
Spencer et al. Pediatric Clin N Am 1999:46:915.
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How can we help people with
ADHD?
Treatments for ADHD
•Education
•Medication
•Behavior
Modification
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•Classroom/Workplace Accommodations
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MTA Study—The Largest Study
Comparing ADHD Treatments
Which ADHD treatments (or combination) work best?
1. Medication (MedMgt) vs. Behavioral Tx (Beh) vs.
Combination (Comb) over the long term
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2. State-of-art, intensive MTA treatments vs. standard
care available in the community (CC), over the long
term
See: http://www.myadhd.com/articles.html
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MTA Study—Treatment Groups
Four Treatment Groups (14 months)
1. Medication alone (MPH dosed to last 12 hours)
2. Intensive behavioral treatment alone
a. over 30 sessions for parent training
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b. 8 week summer program
c. behavior therapist for 12 wks in classroom
d. daily reports from school to home
3. Combined medication & behavioral treatment
4. Community-based care (control)
Source: MTA Study Group, Arch Gen Psych, 1999, 56, 1073-1086.
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MTA Study Results
All treatment arms found to be effective on an absolute basis
Medication alone
Medication + behavioral
treatment
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Nearly equally effective
and superior to:
• Behavioral treatment alone
• Community based treatment
Source: MTA Study Group, Arch Gen Psych, 1999, 56, 1073-1086.
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% “Normalized” at 14-Month Endpoint
MTA Groups vs Classroom Controls
100%
80%
60%
88%
68%
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56%
40%
34%
20%
0%
Controls Comb
Med
Beh
25%
CC
Swanson, JM, et al. J. Amer Acad Child Adolesc Psychiatry
, 2001; 40 (2); 168-179.17
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Commonly Used Stimulant
Medications for ADHD
• Methylphenidate (MPH) Products
• Ritalin
short & mid-acting forms
• Concerta
long-acting
• Metadate CD
mid-acting
• Ritalin Click
LA
mid-acting
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• Focalin
mid-acting
• Amphetamine Products
• Adderall
mid-acting
• Adderall XR
long-acting
• Dexedrine
mid-acting spansule
• Dextrostat
mid-acting
Short acting = 3-5 hours; Mid-acting = 6-8 hours; Long acting = 12 hours+
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Commonly Used Non-Stimulant
Medications for ADHD
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Nonstimulant Products
• Strattera
long-acting
• Other Nonstimulants Products
• Wellbutrin
long-acting
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• Tenex
mid-acting
• Clonidine
mid-acting
Short acting = 3-5 hours; Mid-acting = 6-8 hours; Long acting = 12 hours+
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Efficacy of Medication for ADHD
• Improvements in core symptoms
 reduced hyperactivity
 reduced impulsivity
 improved attention
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• Improvements in related symptoms
 reduced oppositional behavior
 Improved social relations
 improved academic performance
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Adverse Effects of Stimulants
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insomnia
decreased appetite
weight loss
headache
irritability
Stomachache
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rebound agitation
or exaggeration
pre-medication
wearing off
Precautions
Use cautiously in patients with marked anxiety, motor tics or with family
history of Tourette syndrome, or history of substance abuse. Don't use if
glaucoma or on MAOI. Abuse potential particularly in tablet form.
Always consult your physician before using ADHD medications.
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Adverse Effects of Strattera
In children
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decreased appetite
GI upset (can be reduced if medication taken with food)
sedation (can be reduced by dosing in evening)
lightheadedness
In adults
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 insomnia
 sexual side effects
 increased blood pressure
Precautions
Use cautiously in patients with hypertension, tachycardia, or cardiovascular or
cerebrovascular disease because it can increase blood pressure and heart rate. Has
some drug interactions. While extensively tested, short duration of population use.
Always consult your physician before using ADHD medications.
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Using Medication Effectively
• American Academy of Pediatrics recommends that for
treatment of ADHD physicians start with a low dose of
medication and tritrate upward to find the optimal dose.
• Optimal dose
is the
best Master
individualized
response with
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minimal side effects.
• Have a system in place to monitor treatment outcomes
to find the optimal dose and adverse effects.
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Your child’s educational rights
Students with ADHD are protected under
three laws that serve disabled individuals:
•IDEA—Individuals with Disabilities in
Education
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•Section 504 of the Civil Rights Act
•ADA—Americans with Disabilities Act
Work with the child’s school to see if the child qualifies
for special education or for an accommodation plan.
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How teachers can help
Teachers can provide accommodations in the classroom—for
example:
Preferential seating
Shorter assignments
Closer supervision
Clearer instructions
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Help in getting started on assignments
Closer supervision of homework
Frequent communication with parents/doctors
Daily report card program
Allow time for movement
Extra set of books
Environment with fewer distractions during tests
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How parents can help
Parents can help their child who has ADHD by doing the following:
Act, don’t yak when disciplining
Take a disability perspective
Manage behavior at the point of performance
Use rewards and incentives more than punishments
 Work closely with the school
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Know what
yourto
child’s
in school
Provide close supervision for homework
Help your child stay organized
Monitor the child’s performance and let doctors know
Find the things your child does well and encourage them
Get additional help for academic skill problems if needed
Learn as much about ADHD as you can
Maintain a good sense of humor
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Conclusions
• ADHD is a chronic condition that has significant affects on learning,
behavior, socialization, and performance across the lifespan.
• Multimodal treatments work best and involve a combination of
education about the condition, medication, counseling, behavior
management, and school and workplace accommodations and
interventions.
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• Schools can provide special education or accommodations to
students with ADHD who qualify for programs
• Teachers and parents can make adjustments to improve the
performance and self-esteem of children with ADHD
• Enhanced communication among stakeholders (providers, parents,
educators, adults with ADHD) can lead to maximum improvement.
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Resources
Children and Adults with
Attention Deficit /Hyperactivity
Disorders (CHADD)
www.chadd.org
Attention Deficit Disorders
Association (ADDA)
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http://www.add.org/
American Academy of Child and
Adolescent Psychiatry (AACAP)
http://www.aacap.org/
American Academy of Pediatrics
www.aap.org
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A.D.D. title
WareHouse
Learning Disability Association of
America
http://www.ldanatl.org/
www.addwarehouse.com
myADHD.com
www.myadhd.com
See: http://www.myadhd.com/organizations.html
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