Attention Deficit Hyperactivity Disorder ADHD

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Attention Deficit/ Hyperactivity Disorder (AD/HD)
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History Early Conceptualizations of ADHD

• Emphasis on attention vs. hyperactivity changed

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AD/HD HistoryDSM-III

• Attention Deficit Disorder with or without
  hyperactivity
• Attention deficits were the focus (not
  hyperactivity)

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AD/HD History DMS-III-R

• Attention Deficit Hyperactivity Disorder
• Mix of inattention and hyperactivity
• Attention was somewhat primary

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AD/HD History DSM-IV

• Attention Deficit/Hyperactivity Disorder
• Factor analytic studies resulted in two factors
  attention and hyperactivity

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AD/HD Diagnostic Criteria Inattention

• Makes careless mistakes
• Difficulty sustaining attention
• Does not seem to listen when spoken to directly
• Does not follow through on instructions, fails to
  finish work
• Difficulty organizing tasks
• Avoids sustained effort tasks
• Loses things
• Easily distracted
• Often forgetful

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Attention

• Selective Attention (Distractibility) attention
  to relevant stimuli
• Sustained Attention (Vigilance) attention to a
  task over a period of time Continuous
  Performance Test
• Attention capacity-amount of information in
  short-term memory

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AD/HD Diagnostic Criteria Hyperactivity/Impulsivi
ty

• Hyperactivity
• Often fidgets with hands or feet or squirms
• Often leaves seat
• Often runs about or climbs excessively
• Difficulty engaging in activities quietly
• Often on the go, driven
• Talks excessively
• Impulsivity
• Blurts our answers
• Difficulty waiting turn
• Frequently interrupts

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Dimensions of Impulsivity

• Cognitive Impulsivity
• Disorganization
• Hurried thinking
• Need for supervision
• Behavioral Impulsivity

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AD/HD Subtypes

• Attention Deficit/Hyperactivity Disorder
  predominantly inattentive type
• Attention Deficit/Hyperactivity Disorder
  predominantly hyperactive-impulsive type
• Attention Deficit/Hyperactivity Disorder
• Combined type

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Problems with AD/HD Criteria

• Symptoms are not developmentally sensitive
• Just below threshold problem
• Criteria for age of onset is questionable
• Criteria of symptoms for 6 months may be too
  short for preschoolers

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AD/HD Prevalence

• Prevalence rates 2-12
• More common in males
• Cultural variation in rates

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AD/HD Co morbidity

• Oppositional Defiant Disorder
• Conduct Disorder
• Anxiety Disorder
• Depression

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Etiology AD/HD Neurological

• Abnormal Brain Structure- normal brain is
  assymetrical with right side being somewhat
  larger than left.
• In AD/HD
• -Smaller right frontal area or
• Left and right sides equal size
• Abnormal Functioning- underactive
  frontal-striatal area (dopamine and
  norepinephrine)

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Etiology AD/HD Genetic

• There is strong evidence for genetic influence.
• Family studies between 10 and 35 of first
  degree family members are likely to have AD/HD.
• Twin Studies Concordance rate identical twins
  (65) is about twice that for fraternal twins .
• Specific Gene Studies dopamine transporter gene,
  gene that codes for dopamine receptor gene, and
  multiple interacting genes on several chromosomes

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Etiology AD/HD Environmental Influences

• Not influenced by
• Parental management of the child
• Diet, allergies, lead
• Can complicate
• Family interactions and stress

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Etiology AD/HD Russel Barkley Theory

• Self-Regulation begins with behavioral
  inhibition.
• Those with ADHD are not able to inhibit their
  responses

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Treatment AD/HD Medication

• Medication is the most effective treatment
• Dr. Charles Bradleys accidental discovery

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Treatment AD/HDMedication

• Psychostimulants
• Methylphenidate (Ritalin)
• Amphetamine (Dexedrine)
• Magnesium Pemoline (Cylert)
• Side Effects Psychostimulants
• Growth delay (time limted)

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Treatment AD/HD Medication

• Tricyclic Antidepressants (Inimpramine)-effective
• Side effects-effects on heart rate and blood
  pressure
• Caffeine some effectiveness-further study needed

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Why Are Stimulants Effective?

• Barkleys theory
• Alter fronto-striatal brain activity through
  effect on neurotransmitters dopamine,
  norepinephrine and epinephrine

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Treatment AD/HD Behavioral

• Parent management training
• Taught about AD/HD
• Taught behavioral control techniques
• School-based Educational Interventions
• Behavior modification applied in the classroom

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Treatment School-based Interventions

• Behavior Modification applied in the classroom
  reward systems, consequences for off task
  behavior, developing cues

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Treatment Individual Therapy

• Behavior Therapy
• Cognitive-Behavioral Self-Control Training
• Individual Counseling
• Social Skills Training

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Treatment Multimodal Intervention Study Design

• National Study
• 600 children ages 7-9
• Randomly assigned to
• --Medication alone
• --Psychosocial/behavioral tx. alone
• --Combination Treatment
• -- Routine Community Care (Control)

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Treatment Multimodal Intervention Results

• For AD/HD Symptoms
• --Meds alone Combined TreatmentgtPsychosocial/Beh
  avior Routine Community Care
• For Other Areas of Functioning
• --Combined treatmentgt Rountine community Care
• --Meds. AloneRoutine Community Care