Attention Deficit Hyperactivity Disorder (ADHD)

Who created “The Story of Fidgety Philip?”

Dr. Heinrich Hoffman (1845)

Who studied a group of impulsive children with significant behavioral problems?

Sir George F. Still (1902)

Who used amphetamine treatments?

Dr. Charles Bradley (1937)

Who named the disorder “Attention Deficit Disorder”

DSM (1980)

Fast facts about ADHD

most common neurological disorder and average onset is 7 years old

boys 4x more likely than girls to have the disorder

What are the four subtypes of ADHD?

Combined (both attention and hyperactive)

Predominately inattentive (sufficient inattentive symptoms)

Predominately hyperactive-impulsive (sufficient hyperactive)

Other (some characteristics, but do not meet diagnostic criteria of other 3 types)

What is the Etiology of ADHD?

the underlying causes remain largely unknown

genetics may play a significant role

likely that ADHD develops as a result of the interaction between multiple genetic risk variants each having a small effect

Etiology: Neurologic function

neurotransmitter (dopamine currently receives most attention)

no single genetic factor identified

Prevalence of ADHD in children

overall 9.5% of school-aged children

388k children aged 2 to 5 years

4 million aged 6 to 11 years

3 million aged 12 to 17 years

Prevalence of ADHD in Adults

4 to 5% of US population

How many signs must be present for the inattentive signs?

5 or 6 signs

How many signs must be present for the Hyperactive impulsive signs?

5 or 6 signs

What are some important features to keep in mind?

normal child behavior includes sometimes having a high level of activity

children mature at different rates

personalities, temperaments, and energy levels all vary

represents the extreme end of a normal continuum for behaviors related to attention, inhibition, and the regulation of activity level

Diagnosis for ADHD

tough (no single test available to diagnose a child or adult)

made based on observation and report

symptoms must be present prior to 12 years of age

What are some things to rule out for ADHD?

visual acuity concerns and Ocular-motor dysfunction

hearing issues

metabolic disorders/genetic disorders

other psychiatric condition

Mild ADHD

few symptoms

Moderate ADHD

somewhere in between

Severe ADHD

many symptoms

Assessment for ADHD

BASC 32

Rating scale for children

Achenbach System of Empirically Based Assessment

Child Behavior Checklists for Parents and Teachers (CBCLs)

Assessment for specifically Adults

ADD Rating Scale and Adult Self Report Scale

What is there to rule out for co-morbid conditions with ADHD?

80% of children with ADHD at risk of having one other disorder

DCD is a motor based disorder

High risk of sensory processing challenges in kids

High association with substance abuse, PTSD, OCD, Bipolar in adults

What is the course/prognosis of ADHD

no cure; lifelong disorders (half continue to meet criteria in adulthood)

overactivity or hyperactivity tends to subside with age

attention and disorganization continue

most adults learn to cope with and manage symptoms

Children with ADHD

30-50% receive special education

higher school dropout rates

lower GPA and fewer enter college

Pharmacologic: Stimulants

Methylphenidate (MPH; Concerta, Ritalin)

Dextroamphetamine (Adderall, Dexedrine)

Pharmacologic: Non-stimulants

Norepinephrine reuptake inhibitors (Atomoxetine)

Alpha-2 adrenergic agonists (Guanfacine, Clonidine)

Calming effect with meds for ADHD

improves inattention, impulsivity, and overactivity

Treatment for ADHD: Non-pharmacologic

counseling, coaching, cognitive behavioral therapy

child focused behavioral activation therapy

mindfulness

parent and teacher education

Treatment for ADHD: OT

sensory processing, problem-solving strategies, adaptive behaviors/accommodations, and medication management