Download Attention Deficit Hyperactivity Disorder

Attention Deficit Hyperactivity
Disorder
Carolyn R. Fallahi, Ph. D.
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.
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).
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
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
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
Controversies and Unresolved Issues
 The issue involving the diagnosis of ADHD, inattentive type.
 What is normal versus clinical?
 ADHD diagnosis and age.
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
Co-morbidity
Additional problems for patients with
ADHD
 Intelligence and academics
 Problems with family and peer relationships
 Emotional dysregulation
 Sleep and health problems
Developmental course of ADHD
 Problems across the lifespan
Etiology of ADHD
 Genetic explanations
 Neurological explanations
 Structural problems within the brain
 Neurotransmitters
 Prenatal explanations
 Social explanations
Treatments for ADHD
Stimulants and ADHD
 Mechanism of action
 Common Stimulants used to treat ADHD
Brand name
generic name
Ritalin
methylphenidate
Dexadrine
dextroamphetamine
Cylert
Pemoline
properties
half life 2-4 hours; effective 3-6
hours; low anorectic and cardiac
effects; often preferred by children
half life 6-12 hours; effective for 4-6
hours; larger anorectic, cardiac
effects; insomnia
half life 12 hours; effective 12-24
hours; lowest stimulant effect; low
abuse potential