Attention Deficit Hyperactivity Disorder
ADHD Definition
Persistent pattern of inattention and/or hyperactivity-impulsivity that’s more frequent & severe than is typically observed in individuals at a comparable level of development
Symptoms
- Inattention
o Difficulty w/sustained attention in tasks or play
o Poor follow through on instructions & fails to finish schoolwork, chores or duties
- Hyperactivity
o Fidgets or squirms in seat
o Inappropriately runs about or climbs excessively
o Difficulty playing quietly
o Talks excessively
- Impulsivity
o Blurts out answers
o Difficulty awaiting turn
Duration
- Has to go on at least 6 mo
- Requires onset before age 7, however this is being modified for adult diagnosis
Subtypes
- Combined type – most common
- Predominately inattentive type – not a lot of hyperactivity
- Predominately hyperactive-impulsive type – not a big problem w/inattentiveness
Prevalence
- 3-5% in school age children (estimated) – increase to 9% in US
- 6-9:1 male to female ratio – may be under-diagnosed in females, since females tend not to be as hyperactive
Etiology
- Brain damage – some subtle CNS damage
- Maturational lag
o Most of kids develop beyond d/o (once in puberty, tend to deal w/d/o)
o Girls CNS develops faster, that may be why ADHD is more prevalent in boys
- Genetics
o Very common to find 1st-degree relatives w/ADHD
o Increased risk for other behavioral d/os
- Neurotransmitters – unsure
Asso’d features
- Learning disabilities – kids need to be tested for LDs
- Secondary social & emotional problems – peer don’t like them, etc
- Antisocial & impulse problems
Differential diagnosis & diagnostic evaluation
- Diagnosis
o Behaviors must occur in more than one setting – kids tend to do better in new situations
o Rating and testing
§ Conners rating scale
- Has parent & teacher versions
- Help to monitor efficacy of tx
§ Psychological testing
- Not clear cut test for ADHD
- Differential diagnosis considerations
o Normal kid?
o Mental retardation – mental age vs. physical age
o Under-stimulating environment
o Abusive environment (over-stimulating)
o Affective d/os
Tx & outcome
- Multi-modal intervention appears most successful – medication + other type of intervention
- Medication
o Psychostimulants – hits all 3 symptom areas
o Other medications – antidepressants
- Psychotherapy/behavior modification – addresses psychosocial fall-out of d/o or co-morbid d/os
- Prognosis – not really clear
o Persist into adulthood – not sure of prevalence
o Symptoms of ADHD ¯ in adulthood, or can go away altogether
o Medication still effective in adulthood
o Majority make good adjustment
§ Some studies report that 25% develop Antisocial Personality D/o
Tags: Antisocial Personality, behavior modification, brain damage, hyperactivity, inattention, Learning disabilities, maturational lag, Mental retardation, Psychostimulants, Psychotherapy
