PEC - Chapter 8: Attention Deficit Hyperactivity Disorder

Attention Deficit Hyperactivity Disorder

Consists of a persistent pattern of inattention and/or hyperactivity and impulsive behavior that is more severe than expected of children of similar age and level of development.

Attention Deficit Hyperactivity Disorder

Symptoms must be present before the age of 7 years, must be present in at least two settings, and must interfere with the appropriate social, academic, and extracurricular functioning.

Diagnosis of ADHD

Principle signs are based on history of child’s developmental patterns and direct observation in situations requiring attention.

Diagnosis of ADHD

Typical signs include talking excessively, persevering, fidgeting, frequent interruptions, impatience, difficulty organizing and finishing tasks, distractibility, and forgetfulness.

Epidemiology of ADHD

Occurs in 3% to 7% of grade-schoolers

Epidemiology of ADHD

More prevalent to boys than girls

Epidemiology of ADHD

Symptoms often present by 3 years

Etiology of ADHD

Possible causes include perinatal trauma and genetic and psychosocial factors

Etiology of ADHD

Evidence of noradrenergic and dopaminergic dysfunction in neurotransmitter systems

Etiology of ADHD

Frontal lobe hypoperfusion and lower frontal lobe metabolic rates have also been noted

Etiology of ADHD

Soft neurological signs are found in higher rates among children with this disorder

ADHD

Soft neurological signs are found in higher rates among children with this disorder

Differential Diagnosis of ADHD; Bipolar 1 Disorder

There is more waxing and waning of symptoms

Differential Diagnosis of ADHD; Mania

Irritability may be more common than euphoria

Differential Diagnosis of ADHD; Learning Disorders

Inability to do math or read is not because of inattention

Differential Diagnosis of ADHD; Depressive Disorder

Distinguished by hypoactivity and withdrawal

Differential Diagnosis of ADHD; Anxiety Disorder

may be manifested by overactivity and easy distractibility

Course and Prognosis of ADHD

Course is variable. Most patients undergo partial remission.

Course and Prognosis of ADHD

Inattention is frequently the last remitting symptom

Course and Prognosis of ADHD

Patients are vulnerable to antisocial behavior, substance use disorders, and mood disorders

Course and Prognosis of ADHD

Learning problems often continue throughout life

Treatment and Intervention for ADHD

Biological and Psychological

Biological (medication) for ADHD

Improves compliance

Biological (medication) for ADHD

Decreases negative behaviors

Biological (medication) for ADHD

Effects not long term

Psychological (behavioral)

Goal-setting and reinforcement

Psychological (behavioral)

Social skills training

Psychological (behavioral)

Applied Behavioral Analysis

Diagnostic Criteria for ADHD

A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterize by (A1) Inattention and/or (A2) Hyperactivity and Impulsivity

Diagnostic Criteria for ADHD

Inattention: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is consistent with developmental level and that negatively impacts directly on social and academic/occupational activities.

Diagnostic Criteria for ADHD

The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or failure to understand tasks or instructions.

Diagnostic Criteria for ADHD

For older adolescents and adults (age 17 and older), at least five symptoms of this disorder are required.

Inattention Diagnostic Criteria for ADHD

Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details, work is inaccurate)

Inattention Diagnostic Criteria for ADHD

Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading).

Inattention Diagnostic Criteria for ADHD

Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction).

Inattention Diagnostic Criteria for ADHD

Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked).

Inattention Diagnostic Criteria for ADHD

Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganized, work; has poor time management; fails to meet deadlines).

Inattention Diagnostic Criteria for ADHD

Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers).

Inattention Diagnostic Criteria for ADHD

Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, or mobile phones).

Inattention Diagnostic Criteria for ADHD

Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts).

Inattention Diagnostic Criteria for ADHD

Is often forgetful in daily activities (e.g., chores, running errands; for older adolescents and adults, returning calls, paying bills, keeping appointments).

Diagnostic Criteria for ADHD

Hyperactivity & Impulsivity: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities.

Hyperactivity & Impulsivity Diagnostic Criteria for ADHD

Often fidgets with or taps hands or feet or squirms in seat.

Hyperactivity & Impulsivity Diagnostic Criteria for ADHD

Often leaves seat in situations when remaining seated is expected (e.g., leaves his or her place in the classroom, in the office or other workplace, or in other situations that require remaining in place).

Hyperactivity & Impulsivity Diagnostic Criteria for ADHD

Often runs about or climbs in situations where it is inappropriate. (Note: In adolescents or adults, may be limited to feeling restless).

Hyperactivity & Impulsivity Diagnostic Criteria for ADHD

Often unable to play or engage in leisure activities quietly.

Hyperactivity & Impulsivity Diagnostic Criteria for ADHD

Is often “on the go” acting as if “driven by a motor” (e.g., is unable to be or uncomfortable being still for an extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with).

Hyperactivity & Impulsivity Diagnostic Criteria for ADHD

Often talks excessively.

Hyperactivity & Impulsivity Diagnostic Criteria for ADHD

Often blurts out an answer before a question has been completed (e.g., completes people’s sentences; cannot wait for turn in conversation).

Hyperactivity & Impulsivity Diagnostic Criteria for ADHD

Often has difficulty waiting his or her turn (e.g., while waiting in line).

Hyperactivity & Impulsivity Diagnostic Criteria for ADHD

Often interrupts or intrudes on others (e.g., butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission; for adolescents or adults, may intrude into or take over what others are doing).

Diagnostic Criteria for ADHD

Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years.

Diagnostic Criteria for ADHD

Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (e.g., at home, school or work; with friends or relatives; in other activities).

Diagnostic Criteria for ADHD

There is a clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning.

Diagnostic Criteria for ADHD

The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal).

Combined Presentation

If both Criterion A1 (Inattention) and Criterion A2 (Hyperactivity-impulsivity) are met for the past 6 months.

Predominantly Inattentive Presentation

If Criterion A1 is met but Criterion A2 is not met for the past 6 months.

Predominantly Hyperactive-Impulsive Presentation

If Criterion A1 is not met but Criterion A2 is met for the past 6 months.