1. Attention Deficit Hyperactivity Disorder Class Notes EDFN 645 October 22, 2008

2. Diagnostic Criteria ADHD A. Six or more symptoms of either Inattention or Hyperactivity-impulsivity present for at least six months to a degree that is maladaptive and inconsistent with developmental level. Inattention  Often:  Fails to give close attention to details or makes careless mistakes in schoolwork, work or other activities  Has difficulty sustaining attention in tasks or play activities  Does not seem to listen when spoken to directly  Does not follow through on instructions and fails to finish schoolwork, chores or duties in the workplace  Has difficulty organising tasks and activities  Avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort  Loses things necessary for tasks or activities  Easily distracted by extraneous stimuli  Forgetful in daily activities Hyperactivity  Often:  Fidgets with hands, feet or squirms in seat  Leaves seat in classroom or other situations in which remaining seated is expected  Runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)  Has difficulty playing or engaging in leisure activities quietly  "On the go" or acts as if "driven by a motor"  Talks excessively

3. Diagnostic Criteria ADHD cont.  Impulsivity  Often:  Blurts out answers before questions completed  Has difficulty awaiting turn  Interrupts or intrudes on others B. Some symptoms causing impairment were present before 7 years of age. C. Some impairment is present in two or more settings. D. Evidence of clinically significant impairment in social, academic or occupational functioning. E. Symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder and we are not better accounted for by another mental disorder.  ADHD symptoms in adults may present in different ways and very often adults with ADHD experience high levels of disorganisation across work and life circumstances, which they may not initially identify as a manifestation of the disorder. The diagnosis of ADHD in an adult may be first raised when one of their own children is diagnosed with the disorder. Alternatively, as ADHD adults experience high rates of other mental disorders, ADHD may be considered when seeking help for another disorder. Recent increased awareness that adults can be affected with ADHD has assisted many individuals to initiate assessment for themselves, their partner or family member. As reflected in the DSM IV TR

5. ADHD Comorbidity  Conduct Disorder  Depression  Anxiety Disorder  CAPD (not reflected_  Findings by Biederman & Faraone: The Harvard Mahoney Neuroscience Institute Letter Winter 1996

6. Prevalence of ADHD According to CDC 2003 data  In 2003, approximately 4.4 million children aged 4--17 years were reported to have a history of ADHD diagnosis; of these, 2.5 million (56%) were reported to be taking medication for the disorder.  http://www.cdc.gov/ncbdd d/ADHD/adhdprevalence. htm http://www.cdc.gov/ncbdd d/ADHD/adhdprevalence. htm

7. The ADHD Evaluation Initial Interview is usually about 2-1/2 hours. (for me, usually 2 sessions) Besides the standard Integrative Consult: – Need to speak to the parents alone, the child alone, and the family together. – Use some type of standardized questionnaire. – Also speak to teachers, counselors, school psychologists. – Review any previous psychoeducational evaluations or other professional consults.

8. Ritalin Use in the United States  Estimated Number of Children Taking  Ritalin  1970 - 150,000  1980 - Between 270,000 and 541,000;  1990 - 900,000,  2003 - 2.5 million Findings from http://www.salt.arizona.edu/anniversary/SALT%20ADHD% 20talk%20-%20SN.pdf

9. Stimulant Medications and Side-Effects Decreased Appetite Trouble Sleeping Abdominal Pain Headaches Tics Bizarre Behavior Generally, all of these stop when the medication is stopped

10.  Possible Explanations  – We are better at finding and helping children  and adults who really do have ADHD.  – There are more children now who actually  have ADHD  – Toxins in the prenatal and early childhood  environment  – A recent study found over 250 toxins in  umbilical cord blood, including mercury,  pesticides, organochlorines).  – We have loosened the definition so more kids  are being diagnosed  – We are actually diagnosing many children  who don’t have ADHD, even by a loosened  definition. Why the Explosion in ADHD?

11. ADHD Adult Implications

12. Ritalin Use/Abuse in Colleges  In a Midwestern University…”Findings revealed that 17% of 179 surveyed men and 11% of 202 women reported illicit use of prescribed stimulant medication”.  "It's a miracle drug," (a student) told The Boston Globe. "It is unbelievable how my concentration boosts when I use Adderall.“