14. ADHD and Conduct Disorder

Attention Deficit and Hyperactivity Disorder (ADHD)

Definition and Overview

  • ADHD is characterized by inattention, hyperactivity, and impulsivity.

  • Symptoms must persist for at least 6 months.

ADHD - Hyperactive and Impulsive Symptoms

  • Criteria: Six or more symptoms of hyperactivity/impulsivity.

  • Common behaviors reported by parents and teachers:

    • Fidgeting and restlessness in seats.

    • Inability to sit still.

    • Touching and utilizing other students' property.

    • Motor restlessness, especially when demands are high.

ADHD - Secondary Features

Motor Skills

  • Approximately 50% of children with ADHD experience motor coordination problems.

    • Motor clumsiness and delays in achieving motor milestones.

    • Performance in sports can vary significantly.

    • Difficulties with fine motor coordination and timing.

    • Challenges with complex movements.

Intelligence

  • Children with ADHD typically underperform on IQ tests compared to peers.

    • High rates of co-occurring learning difficulties and disorders.

    • Underperformance in academics often necessitates tutoring.

    • Increased likelihood of repeating grades (30% probability).

    • Requirement for special education supports (30-40%).

    • Higher rates of discontinuing formal education (10-35%).

Executive Functioning Skills

  • Difficulties with:

    • Inhibition and self-regulation.

    • Working memory and sustained attention.

    • Planning and organization.

Adaptive/Daily Living Skills

  • Children may underperform on daily living tasks, like personal hygiene and getting ready for school.

Social Behavior

  • Often aloof; may ignore social norms and cues.

    • Examples include interrupting and failing to take turns in conversation.

    • Difficult to process social-emotional cues.

    • Increased relational challenges with peers and future romantic partners.

Conduct Disorders

Overview of Conduct Problems

  • Real-life accounts illustrating family crises due to conduct problems.

  • Example: A mother desperate to seek help for her daughter believes that an act of violence could lead to necessary intervention.

Diagnosis of Conduct Problems (DSM-5)

  • Includes:

    • Disruptive, Impulse-Control, and Conduct Disorders.

    • Oppositional Defiant Disorder (ODD).

    • Conduct Disorder (CD).

    • Intermittent Explosive Disorder.

    • Pyromania and Kleptomania.

    • Antisocial Personality Disorder.

Developmental Pathway

  • ADHD can be a precursor to Antisocial Personality Disorder.

    • This indicates a pervasive pattern of disregard for the rights of others.

    • Criteria for CD should be met before age 15.

Oppositional Defiant Disorder (ODD)

  • Behaviors include:

    • Pattern of negativistic, hostile, and defiant behavior.

    • Needs at least 3 symptoms for at least 6 months:

      • Loses temper; easily annoyed.

      • Argues with adults; defies rules.

      • Annoys others deliberately; blames others for mistakes.

      • Shows spiteful or vindictive behavior.

    • Severity can be classified as Mild, Moderate, or Severe.

Conduct Disorder (CD)

  • Characterized by:

    • A pattern of repetitive and persistent violent acts violating the rights of others.

    • Requires presence of at least 3 behaviors in the last year, with one in the last 6 months.