Carolyn R. Fallahi, Ph. D.

(parts of this lecture taken from Mash/Wolfe

Abnormal Child Psychology)

Attention Deficit Hyperactivity

Disorder

Introduction Nursery rhyme presented in your book by Henrich Hoffman, a

German psychiatrist, (mid 1800s).

Phil, stop acting like a worm; The table is no place to squirm; Thus speaks

the father to his son. Severely says it, not in fun. Mother frowns and

looks around; Although she doesn’t make a sound; But Phillip will not

advise; He’ll have his way at any price; He turns; And churns; He wiggles;

And jiggles; Here and there on the chair; Phil, these twists I cannot bear.

History

1902: George Still (Royal College of Physicians

20th Century: Postencephalitic Behavior Disorder.

Brain Injured Child Syndrome.

Minimal Brain Dysfunction.

Hyperkinetic Impulse disorder (DSM II diagnosis).

Attention Deficit Disorder (DSM III diagnosis).

Attention Deficit Hyperactivity Disorder (ADHD; DSM-IIIR

1987).

The focus of ADHD has changed

self-regulation,

behavioral inhibition,

motivational deficits.

ATTENTION-DEFICIT/HYPERACTIVITY

A. Either (1) or (2):

(1) 6 or more of following have persisted for 6 months to degree that is maladaptive and inconsistent

with developmental level:

Inattention

____ ____ often fails to pay attention to details or makes careless mistakes in school or other

activities

____ ____ often has difficulty sustaining attention

____ ____ often does not seem to listen when spoken to directly

____ ____ often doesn't follow through on instructions and fails to finish things

____ ____ often has difficulty organizing tasks and activities

____ ____ often reluctant to do things requiring sustained mental effort

____ ____ often loses things

____ ____ easily distracted

____ ____ often forgetful

2) 6 or more of following have persisted for 6 months to degree that is maladaptive and inconsistent

with developmental level:

Hyperactivity

____ ____ often fidgets with hands or feet or squirms in seat

____ ____ often leaves seat in class

____ ____ often runs or climbs excessively in inappropriate situations

____ ____ often has difficulty playing quietly

____ ____ often "on the go" or acts as if "driven by a motor"

____ ____ often talks excessively

Impulsivity

____ ____ often blurts out answers before question completed

____ ____ often has difficulty awaiting turn

____ ____ often interrupts or intrudes on others

B. ____ ____ Some symptoms present before age 7

C. ____ ____ Some impairment present in 2 or more settings

D. ____ ____ Symptoms do not occur exclusively during Pervasive Developmental Disorder,

Schizophrenia, are not better accounted for by depression or anxiety

Characteristics of ADHD

Inattention

Attention

Hyperactivity-Impulsivity

Impulsivity

Subtypes of ADHD

Attention Deficit Hyperactivity Disorder – Predominantly

Inattentive Type

Attention Deficit Hyperactivity Disorder – Predominantly

Hyperactive-Impulsive Type

Combined type

Additional DSM Criteria

Additional Criteria necessary to make the diagnosis:

Age

Sex

Duration

Behaviors

Significant impairment

Controversies associated with

ADHD as a diagnosis

What about development?

Categorical versus dimensional view.

Age issues.

Length of time have the diagnosis.

ADHD, inattentive type.

What is normal versus clinical?

Associated Deficits

Cognitive Deficits

Intellectual Deficits

Academics

Co-occurring learning disorders

Speech and language problems

Medical and Physical problems

Problems getting along with family and peers

Prevalence and Course School-age children – 4.8%.

Gender Differences.

Differences in SES.

Differences across cultures.

Differences seen across the lifespan.

Epidemiology

Prevalence: 3-5% children; 2-3% adolescents.

Cultural issues?

Gender differences.

Co-occurring disorders:

Conduct disorder

Depression.

Bipolar Disorder.

Anxiety Disorders.

Learning disorders

Co-morbidity

Additional problems for patients with

ADHD

Intelligence and academics

Problems with family and peer relationships

Emotional dysregulation

Sleep and health problems

Etiology of ADHD

Genetic explanations

Neurological explanations

Structural problems within the brain

Neurotransmitters

Prenatal explanations

Social explanations

Treatments for ADHD

Mash/Wolfe Abnormal Child Psychology, 4th edition © 2009

Cengage Learning

PLAY

VIDEO

VIDEO: Prescription Medication to Treat Children with

ADHD

Stimulants and ADHD

Mechanism of action

Common Stimulants used to treat ADHD

Brand name generic name properties

Ritalin methylphenidate

half life 2-4 hours; effective 3-6 hours; low anorectic and cardiac effects; often preferred by children

Dexadrine dextroamphetamine

half life 6-12 hours; effective for 4-6 hours; larger anorectic, cardiac effects; insomnia

Cylert Pemoline

half life 12 hours; effective 12-24 hours; lowest stimulant effect; low abuse potential

Mash/Wolfe Abnormal Child Psychology, 4th edition © 2009

Cengage Learning

PLAY

VIDEO

VIDEO: Behavior Therapy for Kids with ADHD

ADHDBehav ior.mov