ADHD

ADHD

• ADHD one of the most prevalent and most comfortably diagnosed and treated by pediatricians

• It can be very impairing if untreated

• Often highly treatable with medications which can dramatically improve symptoms and functioning

2 types of ADHD

1. inattention
2. hyperactivity

inattention

six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

(age 17 or older - only 5 symptoms are required).


• (a) often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
• (b) often has difficulty sustaining attention in tasks or play activities • (c) often does not seem to listen when spoken to directly
• (d) often does not follow through on instructions and fails to finish
schoolwork, chores, or duties in the workplace (not due to oppositional
behavior or failure to understand instructions)
• (e) often has difficulty organizing tasks and activities
• (f) often avoids, dislikes, or is reluctant to engage in tasks that require
sustained mental effort (such as schoolwork or homework)
• (g) often loses things necessary for tasks or activities (e.g., toys, school
assignments, pencils, books, or tools)
• (h) is often easily distracted by extraneous stimuli
• (i) is often forgetful in daily activities

DSM 5 symptoms for inattention

-difficultly sustaining attention
-doesnt listen
-no follow through
-cant organize
-loses important items
-easily distractible
-forgetful

hyperactivity-impulsivity

six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:
(Age 17 or older - only 5 symptoms are required).

•Hyperactivity
• (a) often fidgets with hands or feet or squirms in seat
• (b) often leaves seat in classroom or in other situations in which remaining seated is expected
• (c) often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
• (d) often has difficulty playing or engaging in leisure activities quietly
• (e) is often "on the go" or often acts as if "driven by a motor"
• (f) often talks excessively

hyperactivity 5 symptoms

-squirms and fidgets
-cant stay seated
-runs/clibs excessively
-cant play or do work quietly
-on the go
-driven by a motor
-talks excessively

impulsivity

• (g) often blurts out answers before questions have been completed
• (h) often has difficulty awaiting turn
• (i) often interrupts or intrudes on others (e.g., butts into conversations or games)

Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age

12 years. (Was 7 years in DSM IV)

Some impairment from the symptoms is present in

two or more settings (e.g., at school [or work] and at home).

There must be clear evidence of clinically significant impairment in

social, academic, or occupational functioning.

The symptoms do not occur exclusively during the course of a

pervasive developmental disorder, schizophrenia, or other psychotic disorder and are not better accounted for by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, or a personality disorder).

diagnosis requires

thorough history from multiple sources
-assess for DSM symptoms of ADHD
-assess for impairments
-assess for other medical conditions or psychiatric disorders that could mimic ADHD

Prevalance of ADHD

-children 2-18%
-2.4x higher in boys compared to girls
*4:1 for hyperactive and 2:1 for inattentive
-girls more likely to have primarily inattentive presentation

The most persistent symptoms include

inattention, distractibility and poor organization

Without treatment, adolescents with ADHD have

4 times as many serious injuries and
3 times more motor vehicle accidents than those without ADHD or those with ADHD who consistently take medication

Many with ADHD try to

self medicate to improve adaptive functioning

ADHD Comorbidities

• Oppositional Defiant Disorder/Conduct Disorder 30-50% - Comorbid Conduct disorder is a strong predictor of later substance abuse.
• Anxiety Disorders 25-30%
• Learning Disabilities 20-25%

• 70% of persons with Learning Disorders

have ADHD

comorbid disorders with ADHD

Anxiety 47.1%
• Major Depression 18.6%
• Bipolar 19.4%• Substance Use 15.2%
• Dysthymia 12.8%

• Childhood ADHD criteria should be

modified to fit adults

• ADHD persists into

adulthood more than previously thought and results in impairments in a variety of domains

Medication alone was

significantly more effective for core ADHD symptoms than behavioral treatment alone

• Addition of behavioral treatment to medication did not lead to further improvement in outcomes with core symptoms

changing diet for ADHD

• Free Fatty Acid supplementation produced small but
significant reductions in ADHD symptoms.
• Artificial food color exclusions produced larger effects but often in individuals selected for food sensitivities.

simple strategies for kids with ADHD

clear consistent expectations
Use visual cues and reminders when possible
Keep them active - they may need frequent movement breaks
Lots of positive reinforcement!
Limit Distractions
Break larger tasks into smaller chunks

Although not effective for ADHD symptoms themselves,

behavioral interventions may result in other positive effects like reducing oppositional behavior.