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ADHD and           Hyperkinetic                                                                 UNDERGRADUATE             ...
Introduction to the Section• Symptoms of ADHD   – Inattention                                                             ...
Learning Outcomes of this SectionOn completion of the Section and with independent  study you should be able to:          ...
What is ADHD?• Problems with Attention,                                                                                UND...
What is ADHD?• First described around 100 years ago                                                                       ...
What is ADHD?• DSM-IV-TR - Three main subtypes:                                                                           ...
Symptoms of ADHD• Hyperactivity/Impulsivity   – poor self-monitored behaviour.                                            ...
ADHD                      Hyperactivity   Inattention   Inattentive   Combined    Hyperactive-      type         type     ...
Inattention• Failure to pay close attention to details or making careless                                                 ...
Inattention•   Excessive distractibility                                                                                  ...
Hyperactivity-impulsive behaviour•   Fidgeting with hands or feet or squirming in seat                                    ...
Prevalence of ADHD• ADHD is a common developmental disorder affecting 2-5% of  school age children in UK                  ...
Comorbidity                                          ADHD                                                                 ...
Comorbidity• Substance Use Disorders in Adults With                                                                       ...
Comorbidity• Mood and Anxiety Disorders in Adults With  ADHD                                                              ...
Comorbidity• Personality Disorders in Adults With ADHD  –   Anti-social personality (22%)                                 ...
Causes of ADHD• The causes of ADHD are not fully known   – Likely to have multiple causes and complex interactions        ...
DSM• 1980 – The name Attention Deficit Disorder (ADD)                                                                     ...
Diagnostic Criteria for ADHD• Clear DSM criteria but reality is different – clinician’s  judgement                        ...
Developmental Course of ADHD• Preschool and Kindergarten Years                                                            ...
Developmental Course of ADHD• Infancy and Toddler Years                                                                   ...
Developmental Course of ADHD• Primary School Years   – Typically diagnosed in primary                                     ...
Developmental Course of ADHD• Secondary School Years   – Academic difficulties (esp. literacy)                            ...
Developmental Course of ADHD• Adult ADHD                                                                            UNDERG...
Consequences of ADHD• Inattention and Hyperactivity impact on  development generally                                      ...
Consequences of ADHDFollow-up studies of clinical samples suggest that sufferers  are far more likely than normal people t...
Consequences of ADHDMoreover, children growing up with ADHD are more likely to experience:                                ...
Lifespan of ADHD• ADHD is a disorder that persists across  the lifespan                                                   ...
Industry of ADHD
Controversy surrounding ADHD“No mental disability this decade has been assailed by as                                     ...
Weekly Group Seminars  (For on-campus students)• Group meetings for discussion, debate, workshop  activities, videos and l...
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AAA Section 02 ADHD and Hyperkinetic Disorder Ver 04 2013

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  1. 1. ADHD and Hyperkinetic UNDERGRADUATE DisorderLecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 1Section: 2 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 31
  2. 2. Introduction to the Section• Symptoms of ADHD – Inattention UNDERGRADUATE – Hyperactivity/Impulsiveness• Prevalence• Comorbidity• Developmental course of ADHD• Consequences of ADHD• Lifespan• Controversy Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 2 Section: 2 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 31
  3. 3. Learning Outcomes of this SectionOn completion of the Section and with independent study you should be able to: UNDERGRADUATE1. Understand the main symptoms, subtypes and diagnostic criteria relating to Attention- Deficit/Hyperactivity Disorder and Hyperkinetic Disorder.2. Be able to describe Attention-Deficit/Hyperactivity Disorder and Hyperkinetic Disorder in detail. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 3 Section: 2 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 31
  4. 4. What is ADHD?• Problems with Attention, UNDERGRADUATE Hyperactivity & Impulsivity“ADHD is a developmental disability with a childhood onset that typically results in a chronic and pervasive pattern of impairment in school, social and/or work domains, and often in daily adaptive functioning.” Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 4 Section: 2 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 31
  5. 5. What is ADHD?• First described around 100 years ago UNDERGRADUATE• Also known as ADD (now defunct term), Hyperactivity, ‘Hyperkinetic Disorder’ in UK (International Classification of Diseases , ICD-10) (more emphasis on Hyperactivity)• Problems of fine-tuning in the normal brain• Due to imbalance in neurotransmitters noradrenalin and dopamine in parts of the brain responsible for self- monitoring Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 5 Section: 2 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 31
  6. 6. What is ADHD?• DSM-IV-TR - Three main subtypes: UNDERGRADUATE – Predominantly Inattentive Type – Predominantly Hyperactive- Impulsive Type – Combined Type – ADHD not otherwise specified Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 6 Section: 2 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 31
  7. 7. Symptoms of ADHD• Hyperactivity/Impulsivity – poor self-monitored behaviour. UNDERGRADUATE – always ‘on the go’, fidget, restless. – cannot sit still, doesn’t wait for others. – Impatient, always talking, difficulty delaying responses.• Inattention – poor concentration and attention to detail. – does not settle to anything, completing things. – poor ability to organise activities or to engage in tedious activities, or tasks requiring sustained mental effort. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 7 Section: 2 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 31
  8. 8. ADHD Hyperactivity Inattention Inattentive Combined Hyperactive- type type Impulsive type 30% 61% 9% Impulsiveness
  9. 9. Inattention• Failure to pay close attention to details or making careless UNDERGRADUATE mistakes when doing schoolwork or other activities• Trouble keeping attention focused during play or tasks• Appearing not to listen when spoken to• Failure to follow instructions or finish tasks• Avoiding tasks that require a high amount of mental effort and organization, such as school projects• Frequently losing items required to facilitate tasks or activities, such as school supplies Continued… Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 9 Section: 2 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 31
  10. 10. Inattention• Excessive distractibility UNDERGRADUATE• Forgetfulness• Procrastination, inability to begin an activity• Difficulties with household activities (cleaning, paying bills, etc.)• Difficulty falling asleep, may be due to too many thoughts at night• Frequent emotional outbursts• Easily frustrated• Easily distracted Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 10 Section: 2 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 31
  11. 11. Hyperactivity-impulsive behaviour• Fidgeting with hands or feet or squirming in seat UNDERGRADUATE• Leaving seat often, even when inappropriate• Running or climbing at inappropriate times• Difficulty in quiet play• Frequently feeling restless• Excessive speech• Answering a question before the speaker has finished• Failure to await ones turn• Interrupting the activities of others at inappropriate times• Impulsive spending, leading to financial difficulties Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 11 Section: 2 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 31
  12. 12. Prevalence of ADHD• ADHD is a common developmental disorder affecting 2-5% of school age children in UK UNDERGRADUATE• Epidemiologic studies revealed prevalence rates ranging from 4%- 12% in USA for all categorical subtypes in the general population of 6 to 12 year olds• No large scale adult epidemiological studies available• Boys are six times more likely to be referred for help than girls• True ratio in community about 3:1• Boys tend to be more disruptive; girls tend to suffer more silently Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 12 Section: 2 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 31
  13. 13. Comorbidity ADHD UNDERGRADUATE Inhibition Deficits Poor Language Skills (pragmatic skills/ comprehension(Behavioural & verbal self regulation) / verbal fluency) Behavioural & emotional Executive Function Impairment Problems (planning / organising/ (ODD, CD,OCD, Depression) digit span/ following instruction etc.) Motor Coordination Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 13 Section: 2 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 31
  14. 14. Comorbidity• Substance Use Disorders in Adults With UNDERGRADUATE ADHD – Alcohol abuse (15%) – Alcohol dependence (41%) – Substance abuse (45%) – Substance dependence (31%) – Any abuse or dependence (69%) Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 14 Section: 2 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 31
  15. 15. Comorbidity• Mood and Anxiety Disorders in Adults With ADHD UNDERGRADUATE – Major Depression (63%) – Dysthymia (23%) – Bipolar (17%) – Panic Disorder (11%) – Simple Phobia (12%) – Generalized Anxiety (21%) – Obsessive Compulsive Disorder (7%) Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 15 Section: 2 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 31
  16. 16. Comorbidity• Personality Disorders in Adults With ADHD – Anti-social personality (22%) UNDERGRADUATE – Passive aggressive personality (19%) – Borderline personality (14%) – Histrionic personality disorder (11%) – Avoidant (Anxious) (11%) Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 16 Section: 2 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 31
  17. 17. Causes of ADHD• The causes of ADHD are not fully known – Likely to have multiple causes and complex interactions UNDERGRADUATE – Good evidence for genetic component – Evidence of structural and functional brain abnormality• The genetic contribution to these traits is routinely found to be among the highest for any psychiatric disorder (70–95% of trait variation in the population), nearly approaching the genetic contribution to human height. (ICS, 2002).• Environment impacts on genes Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 17 Section: 2 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 31
  18. 18. DSM• 1980 – The name Attention Deficit Disorder (ADD) UNDERGRADUATE was first introduced in DSM-III, the 1980 edition.• 1987 – The DSM-IIIR was released changing the diagnosis to "Undifferentiated Attention Deficit Disorder.“• 1994 – DSM-IV described three groupings within ADHD, which can be simplified as: mainly inattentive; mainly hyperactive-impulsive; and both in combination. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 18 Section: 2 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 31
  19. 19. Diagnostic Criteria for ADHD• Clear DSM criteria but reality is different – clinician’s judgement UNDERGRADUATE• The cut-off between normal-but difficult temperament and ADHD is not clearly definable• No single reliable test for ADHD Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 19 Section: 2 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 31
  20. 20. Developmental Course of ADHD• Preschool and Kindergarten Years UNDERGRADUATE – Very short attention span – Moodiness – Can’t listen long to stories – Motor-skill problems – Highly impulsive – Not interested in playing with other children – Poor self-control when frustrated or angry Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 20 Section: 2 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 31
  21. 21. Developmental Course of ADHD• Infancy and Toddler Years UNDERGRADUATE – Irritability – Shrill, frequent crying – Overactive and restless – Sleep problems – Fussy eater – Difficulty adapting well to changes in the environment – Difficulty nursing and feeding Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 21 Section: 2 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 31
  22. 22. Developmental Course of ADHD• Primary School Years – Typically diagnosed in primary UNDERGRADUATE school years – Falls behind in academic performance – Trouble following rules – Cannot sit quietly – Finds it hard paying attention – Difficulty working cooperatively or productively Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 22 Section: 2 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 31
  23. 23. Developmental Course of ADHD• Secondary School Years – Academic difficulties (esp. literacy) UNDERGRADUATE – Challenge parents authority – Poor self-management – Poor time-awareness / lateness – Forgetfulness – Easily bored – Impulsive and irritable – Immaturity – High-risk behaviours Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 23 Section: 2 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 31
  24. 24. Developmental Course of ADHD• Adult ADHD UNDERGRADUATE – Difficulty with directions (98%) – Poor sustained attention (92%) – Shifting activities (92%) – Easily distracted (88%) – Losing things (80%) – Fidgeting (70%) – Interrupting (70%) Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 24 Section: 2 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 31
  25. 25. Consequences of ADHD• Inattention and Hyperactivity impact on development generally UNDERGRADUATE• Some research characterises ADHD as a ‘developmental lag’• The symptoms of ADHD lead to a vast number of negative consequences and high comorbidity Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 25 Section: 2 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 31
  26. 26. Consequences of ADHDFollow-up studies of clinical samples suggest that sufferers are far more likely than normal people to: UNDERGRADUATE• Drop out of school (32–40%), to rarely complete college (5–10%).• Have few or no friends (50–70%).• Under perform at work (70–80%).• To engage in antisocial activities (40–50%).• To use tobacco or illicit drugs more than normal. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 26 Section: 2 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 31
  27. 27. Consequences of ADHDMoreover, children growing up with ADHD are more likely to experience: UNDERGRADUATE• Teen pregnancy (40%).• Sexually transmitted diseases (16%).• To speed excessively and have multiple car accidents, to experience depression (20–30%).• Personality disorders (18–25%) as adults. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 27 Section: 2 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 31
  28. 28. Lifespan of ADHD• ADHD is a disorder that persists across the lifespan UNDERGRADUATE• Most children are first diagnosed around primary school-age (≥7 years)• A trend away from hyperactivity towards inattention as the child develops• About 60-70% of those diagnosed in childhood carry symptoms into adulthood Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 28 Section: 2 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 31
  29. 29. Industry of ADHD
  30. 30. Controversy surrounding ADHD“No mental disability this decade has been assailed by as UNDERGRADUATE much criticism, scepticism and flat out mockery as ADHD.” Mathew Cohen• Ritalin Debate (…to medicate or not to medicate?)• The concept of ADHD is said to be controversial but this is mainly due to the media and disagreement on treatment• International Consensus Statement on ADHD (2002) – Available from web site (Seminar) Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 30 Section: 2 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 31
  31. 31. Weekly Group Seminars (For on-campus students)• Group meetings for discussion, debate, workshop activities, videos and looking at research UNDERGRADUATE papers/publications. You’ll be expected to do academic reading for these.• Seminar group allocations on Blackboard Group Seminars (For distance-learning students)• Online activities and Forum discussions of academic papers. You’ll be expected to do academic reading for these. Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 31 Section: 2 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 31
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