ADHD: Childhood and Beyond David M. Freed, Ph.D Cross Street SE Salem, OR Phone:

A Brief History of ADHD Fidgety Phil was mentioned in 1865 Fidgety Phil was mentioned in 1865 George Still (1902) described children who were aggressive, defiant, and passionate George Still (1902) described children who were aggressive, defiant, and passionate influenza epidemic survivors influenza epidemic survivors The concept of Minimal Brain Dysfunction The concept of Minimal Brain Dysfunction The rise of medication therapy The rise of medication therapy Subtypes of ADHD Subtypes of ADHD Lingering symptoms of ADHD in adults Lingering symptoms of ADHD in adults

Diagnostic criteria for ADHD: Inattention Six or more of the following symptoms of inattention have persisted and caused significant problems careless mistakes difficulty sustaining attention often does not seem to listen fails to finish assignments avoids effortful tasks easily distracted often forgetful

Diagnostic criteria for ADHD: Hyperactivity and Impulsivity Six or more of the following symptoms of hyperactivity and impulsivity have persisted and caused problems Often fidgets Can’t sit still Feels restless Talks excessively Noisy Has difficulty waiting turn Often interrupts or intrudes

ADHD is frequently associated with other disorders including: Conduct disorders Conduct disorders Learning disabilities Learning disabilities Problems with emotional regulation Problems with emotional regulation Substance abuse Substance abuse Relationship issues Relationship issues Vocational difficulties Vocational difficulties

Other Problems Associated with ADHD Reduced test performance (i.e., IQ) Reduced test performance (i.e., IQ) Impaired planning ability Impaired planning ability Excessive talking Excessive talking Poor organization Poor organization Difficulty with problem solving Difficulty with problem solving Poor rule-governed behavior Poor rule-governed behavior

Other Problems Associated with ADHD Problems with frustration tolerance Problems with frustration tolerance Academic and behavior problems Academic and behavior problems Variable performance across time Variable performance across time More frequent accidents and injuries More frequent accidents and injuries Sleep difficulties Sleep difficulties

ADHD and Co-Occurring Psychiatric Disorders (Adapted from Barkley, 1998) Anxiety Disorders (average 25%) Anxiety Disorders (average 25%) Major Depression (average 25%) Major Depression (average 25%) Bipolar Disorder (most likely 6-10%) Bipolar Disorder (most likely 6-10%) Somatization Disorder (24-35% of adolescents) Somatization Disorder (24-35% of adolescents) Oppositional Defiant Disorder (average 35%) Oppositional Defiant Disorder (average 35%) Conduct Disorder (20-56%) Conduct Disorder (20-56%)

ADHD and Social Functioning (adapted from Barkley, 1998) Poor peer relationships Poor peer relationships Low social acceptance/status Low social acceptance/status Increased aggression against peers Increased aggression against peers Less compliance to requests Less compliance to requests More frequent requests for assistance More frequent requests for assistance More frequent reprimands and consequences More frequent reprimands and consequences Frequent changes: job, relationship, residence Frequent changes: job, relationship, residence

ADHD and Emotional Problems Low self-esteem Low self-esteem Depressed and anxious Depressed and anxious Quick tempered Quick tempered Frequent meltdowns Frequent meltdowns Substance abuse Substance abuse Chaotic personal routines Chaotic personal routines

Features That Support a Diagnosis of ADHD Life-long problems with attention Life-long problems with attention A family history of similar problems (e.g., parents, siblings, children) A family history of similar problems (e.g., parents, siblings, children) Clinical presentation including restlessness, fidgetiness, and verbal digressions Clinical presentation including restlessness, fidgetiness, and verbal digressions

Features That Support a Diagnosis of ADHD History of academic and behavioral problems History of academic and behavioral problems Sleep disorder Sleep disorder Associated features of anxiety Associated features of anxiety Associated features of depression Associated features of depression

ADHD Symptoms are Context- Dependent: Advantage or Disadvantage? High activity level can be an advantage High activity level can be an advantage Mixed handedness is common and often associated with excellent dexterity Mixed handedness is common and often associated with excellent dexterity “Easy sociability” is the flip side of verbal impulsivity “Easy sociability” is the flip side of verbal impulsivity Bias to novelty results in unique solutions Bias to novelty results in unique solutions

ADHD Symptoms: Advantage or Disadvantage? Friends appreciate the genuine expression of emotions (the flip side of “quick tempered”) Friends appreciate the genuine expression of emotions (the flip side of “quick tempered”) ADHD masks symptoms of depression ADHD masks symptoms of depression Hypervigilance to tasks of personal interest Hypervigilance to tasks of personal interest