ADHD

1
ADHD

• Dr. Christopher Gibbins, Ph.D., R.Psyc.
• Clinic Psychologist
• Provincial ADHD Program

2
OBJECTIVES

• Dispelling myths about ADHD
• Access to testing in schools
• Impact of ADHD
• Societal costs of ADHD

3
Myths and Facts about ADHD

• Myth Only hyper kids have ADHD.
• Fact Inattentive subtype accounts for about 1/4
  boys and 1/3 girls with ADHD
• Myth Children grow out of ADHD
• Fact 2/3 children continue to show impairment as
  adults.
• Fact Inattentive symptoms show little decline
  over time.

4
Myths and Facts about ADHD

• Myth Children with ADHD are just energetic.
• Fact Proper diagnosis requires evidence of
  impairment in multiple environments.
• Fact Strong evidence for a genetic/neurological
  cause
• High level of heredity, second only to height.
• E.g. Dopamine receptor/transporter genes (DRD4,
  DRD5, DAT1)-neurotransmitters.
• Research of brain scans indicate decreased size
  and activity in pre-frontal cortex.

5
Myths and Facts about ADHD

• Myth Stimulants lead to drug abuse.
• Fact Stimulants reduce the increased risk of
  drug abuse in children with ADHD.
• Myth Stimulants cure ADHD.
• Fact Stimulants are ineffective in 30.
• Fact Most children have residual impairment.
• Fact Pills do not teach skills. Students with
  ADHD may need remediation and coping skills.

6
Myths and Facts about ADHD

• Myth ADHD is just bad discipline.
• Fact Good behaviour management is crucial for
  many children with ADHD.
• Fact Behavioural strategies do not correct the
  cognitive deficits of ADHD.
• Myth Proven, reliable alternative treatments
  exist.
• Fact Alternative treatments have not been shown
  to be effective.

7
Myths and Facts about ADHD

• Myth ADHD is ia not a learning disability.
• Fact LDs are defined as
• Impairments in processes related to perceiving,
  thinking, remembering or learning
• Lifelong, neurological, affecting learning and/or
  school performance (LDAC, 2002)
• Fact ADHD is a neurological, lifelong impairment
  in cognitive processes which affects learning and
  school performance.

8
Access to testing in schools

• Schools have access to most of the information
  necessary to identify children with ADHD
• School based teams are well placed to screen
  children for possible ADHD and provide crucial
  information to diagnosticians.
• Access to professionals trained and qualifies to
  diagnose ADHD is lacking. Most children with ADHD
  either have no access to testing or wait 2-4
  years.
• Training is required to teach effectively, avoid
  over-, under- and mis-diagnosis, and to identify
  co-morbidity.

9
Access to testing in schools

• Diagnosis can be made by psychologists or
  physicians trained to identify ADHD.
• Access to academic assessment allows
  identification of areas requiring remediation and
  areas of underperformance.
• Diagnosis of ADHD requires multiple sources of
  information and informed clinical judgment.
• Diagnosis of ADHD does not usually require
  extensive psychometric testing, expensive
  computerized hardware.

10
Impact on Children

• Increased risk of
• Learning difficulties (reading, writing, math)
• Academic underperformance, teacher conflict
• Academic failure / dropping out
• Victimization, social rejection, isolation
• Aggression and antisocial behaviour
• Anxiety and depression
• Substance use, pregnancy, STDs, accidents, injury

11
CRISIS POINTS Children/Youth

• Infancy colic
• Preschool circle time, pre-academic skills
• Grade 4 increased scholastic and social
  demands
• High school increased planning demands,
  decreased structure, peer pressures, relative
  developmental delay / immaturity

12
Impact on Adults

• The gap between by potential and my achievements
  is huge.
• Variability is enormous, but
• Academic underperformance Loss of income and
  career choices, derailment in higher education
• Difficulties managing money, paying bills/taxes,
  saving for retirement
• Career instability, conflicts with
  employers/clients
• Instability in intimate relationships, poor
  social networks
• Temper, driving, criminality, substance abuse
• Consequences of past experiences

13
Impact on AdultsADHD parents, ADHD kids

• ADHD kids will often have at least one ADHD
  parent. Challenges with
• Patience
• Awareness of own childs moods
• Organization planning
• Inability to assist child in attention demanding
  tasks
• Difficulty soothing child
• Marital conflict and single parent families

14
Societal Costs of Untreated / Undiagnosed ADHD

• Less educated, less skilled citizens and
  workforce
• Higher rates of adult psychopathology, substance
  abuse, criminality
• Multigenerational impairment
• Greater medical, legal, social service costs
• Poorer classroom functioning
• Impact on parents, siblings and community
• Early intervention is cheaper than the
  consequences of impairment