Transcript This is Where You Type the Slide Title

ADHD
- Some symptoms present before 7 yrs old.
- Must be present in 2+ contexts (e.g. school, work, home, social)
PREDOMINANTLY INATTENTIVE TYPE
For 6+ months, 6+ symptoms of inattention
PREDOMINANTLY HYPERACTIVE-IMPULSIVE TYPE
For 6+ months, 6+ symptoms of hyperactivity
and or impulsivity
COMBINED TYPE
For 6+ months, BOTH of the above
Predominantly Inattentive Type
6+ months of 6+ symptoms of inattention to a degree that is
maladaptive and inconsistent w/ developmental level:
• often fails to give close attn to details or makes careless mistakes
• often has problems sustaining attention in tasks or activities
• often doesn’t seem to listen when spoken to directly
• often has problems following through on instructions and fails to
finish schoolwork, chores, or duties
• often has problems organize task or activities
• dislikes tasks that require sustained mental effort
• often loses things
• often easily distracted by extraneous stimuli
• often forgetful in daily activities
Predominantly Hyperactive-Impulsive Type
6+ months of 6+ symptoms of hyperactivity-impulsivity to a degree
that is maladaptive and inconsistent w/ developmental level:
HYPERACTIVITY
• often fidgets w/hands or squirms in seat
• often leaves seat in situations when remaining seated is
expected
• often runs or climbs excessively when inappropriate (in
adolescents, manifested as feelings of restlessness)
• often can’t quietly engage in leisure activity
• often “on the go” or “driven by a motor”
• often talks excessively
IMPULSIVITY
• often blurts out answers before questions completed
• often has problems awaiting turn
• often interrupts or intrudes on others (e.g. conversations, games)
symptom exceptions
SYMPTOMS OFTEN AREN’T DISPLAYED WHEN PATIENT IS:
- frequently rewarded
- closely supervised
- in a new setting
- especially interested in a topic or task
- in one-on-one situations
areas of debate
SYMPTOM CRITERIA ISSUES
- ADHD lacks sufficient research in girls and adults.
- The hyperactivity diagnostic symptoms over-represent
symptoms seen in children (rather than in adults w/ ADHD).
- Age 7 cutoff perhaps not meaningful.
ADHD IN TEENS & ADULTS
- STDs or teen pregnancy
- driving incidents (e.g. tickets, crashes, etc.)
- impairment at job
stats
PREVALENCE
- 3 - 7%
- ADHD is overdiagnosed. (Only 1/3 of pediatricians or
family doctors use testing.)
SEX DIFFERENCES
- Sex Ratio: males outnumber females 2-9 : 1
- females (often inattentive type), males (often H-I type)
ADULT ADHD
- half continue with inattentive problems into adulthood
treatment
BEHAVIORAL THERAPY
Reinforcements for attentiveness, self-control, etc.
MEDICATION
Methylphenidate (Ritalin)
D-amphetamine (Dexedrine, Adderall)
- Use is 5x higher in US than other countries.
- Often prescriptions are given after inaccurate diagnosis.
- Only 1/3 to 2/3 of patients benefit.
- Medication abused by teens, college students, adults.
- Unsafe when not accurately diagnosed:
- insomnia & stunted body/brain growth (HGH)
- psychosis
- facial tics
- addiction
biological explanations
GENETIC COMPONENT
- 80% heritability
- Increased in 1st deg relatives
ENVIRONMENTAL FACTORS
- increased assn to perinatal insults (e.g. exposure to alcohol,
tobacco, lead, etc.)
BRAIN AREAS IMPLICATED
ADHD pts behave similar to frontal lobe injury patients
- prefrontal cortex (inattentiveness & disinhibition)
- basal ganglia
DOPAMINE IMPLICATED
Medications that improve ADHD are known dopamine
agonists.
Is it really ADHD?
How to differentially diagnose from bipolar
disorder?
- age of onset
- duration
- history of disruptive behavior & teacher
complaints
- uncompleted projects