ADHD and Hyperkinetic Disorder Simon Bignell – Module Leader Lecture 2 Spring 2010 (6PS048 & 6PS052)
Introduction to the Lecture <ul><li>Symptoms of ADHD </li></ul><ul><ul><li>Inattention </li></ul></ul><ul><ul><li>Hyperact...
Learning outcomes of this lecture <ul><li>On completion of the lecture and with independent study you should be able to: <...
What is ADHD? <ul><li>Problems with Attention, Hyperactivity & Impulsivity </li></ul><ul><li>“ ADHD is a developmental dis...
What is ADHD? <ul><li>First described around 100 years ago </li></ul><ul><li>Also known as ADD, Hyperactivity, Hyperkineti...
What is ADHD? <ul><li>DSM-IV-TR - Three main subtypes:   </li></ul><ul><ul><li>Predominantly Inattentive Type  </li></ul><...
<ul><li>Hyperactivity/Impulsivity </li></ul><ul><ul><li>poor self-monitored behaviour. </li></ul></ul><ul><ul><li>always ‘...
ADHD Impulsiveness Inattention Combined type Hyperactive- Impulsive type Inattentive   type Hyperactivity 61% 30% 9%
Inattention <ul><li>Failure to pay close attention to details or making careless mistakes when doing schoolwork or other a...
Inattention <ul><li>Excessive distractibility  </li></ul><ul><li>Forgetfulness  </li></ul><ul><li>Procrastination, inabili...
Hyperactivity-impulsive behaviour <ul><li>Fidgeting with hands or feet or squirming in seat  </li></ul><ul><li>Leaving sea...
ADHD (Video) <ul><li>Video - 9 year old child with ADHD </li></ul>Video viewable from the module website.
<ul><li>ADHD is a common developmental disorder affecting 2-5% of school age children in UK </li></ul><ul><li>Epidemiologi...
Comorbidity ADHD Poor Language Skills (pragmatic skills/ comprehension  / verbal fluency) Executive Function Impairment (p...
Comorbidity <ul><li>Substance Use Disorders in Adults With ADHD </li></ul><ul><ul><li>Alcohol abuse (15%) </li></ul></ul><...
Comorbidity <ul><li>Mood and Anxiety Disorders in Adults With ADHD </li></ul><ul><ul><li>Major Depression (63%) </li></ul>...
<ul><li>Personality Disorders in Adults With ADHD </li></ul><ul><ul><li>Anti-social personality (22%) </li></ul></ul><ul><...
Causes of ADHD <ul><li>The causes of ADHD are not fully known </li></ul><ul><ul><li>Likely to have multiple causes and  co...
DSM <ul><li>1980 – The name  Attention Deficit Disorder  (ADD) was first introduced in DSM-III, the 1980 edition.  </li></...
<ul><li>Clear DSM criteria but reality is different – clinician’s judgement </li></ul><ul><li>The cut-off between normal-b...
<ul><li>Preschool and Kindergarten Years </li></ul><ul><ul><li>Very short attention span </li></ul></ul><ul><ul><li>Moodin...
<ul><li>Infancy and Toddler Years </li></ul><ul><ul><li>Irritability </li></ul></ul><ul><ul><li>Shrill, frequent crying </...
<ul><li>Primary School Years </li></ul><ul><ul><li>Typically diagnosed in primary school years </li></ul></ul><ul><ul><li>...
<ul><li>Secondary School Years </li></ul><ul><ul><li>Academic difficulties (esp. literacy) </li></ul></ul><ul><ul><li>Chal...
Developmental Course of ADHD <ul><li>Adult ADHD </li></ul><ul><ul><li>Difficulty with directions (98%) </li></ul></ul><ul>...
<ul><li>Inattention and Hyperactivity impact on development generally </li></ul><ul><li>Some research characterises ADHD a...
Consequences of ADHD <ul><li>Follow-up studies of clinical samples suggest that sufferers are far more likely than normal ...
Consequences of ADHD <ul><li>Moreover, children growing up with ADHD are more likely to experience: </li></ul><ul><li>Teen...
<ul><li>ADHD is a disorder that persists across the lifespan </li></ul><ul><li>Most children are first diagnosed around pr...
Industry of ADHD
Controversy surrounding ADHD <ul><li>“ No mental disability this decade has been assailed by as much criticism, scepticism...
Any Questions?
Group Seminars  (For campus-based students) <ul><li>Group meetings for discussion, debate, workshop activities, videos and...
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Topic 2 - ADHD and Hyperkinetic Disorder 2010

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Autism, Asperger's and ADHD.
Lecture 2.

The views expressed in this presentation are those of the individual Simon Bignell and not University of Derby.

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  • Excellent posting! You might appreciate this additional set of criteria on the biomedical side:
    http://slidesha.re/1aLiWuA
    cp
    Author: New ADHD Medication Rules - Brain Science & Common Sense
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  • helpful website that may help others. This website has practice exams for various nursing classes as well as videos, presentations, notes, nclex help, and many other tools that already are helping me. Hope they help


    http://www.rnpedia.com/
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Topic 2 - ADHD and Hyperkinetic Disorder 2010

  1. 1. ADHD and Hyperkinetic Disorder Simon Bignell – Module Leader Lecture 2 Spring 2010 (6PS048 & 6PS052)
  2. 2. Introduction to the Lecture <ul><li>Symptoms of ADHD </li></ul><ul><ul><li>Inattention </li></ul></ul><ul><ul><li>Hyperactivity/Impulsiveness </li></ul></ul><ul><li>Prevalence </li></ul><ul><li>Comorbidity </li></ul><ul><li>Developmental course of ADHD </li></ul><ul><li>Consequences of ADHD </li></ul><ul><li>Lifespan </li></ul><ul><li>Controversy </li></ul>
  3. 3. Learning outcomes of this lecture <ul><li>On completion of the lecture and with independent study you should be able to: </li></ul><ul><li>  </li></ul><ul><li>1.     Understand the main symptoms, subtypes and diagnostic criteria relating to Attention- Deficit/Hyperactivity Disorder and Hyperkinetic Disorder. </li></ul><ul><li>  </li></ul><ul><li>2.     Be able to describe Attention-Deficit/Hyperactivity Disorder and Hyperkinetic Disorder in detail. </li></ul>
  4. 4. What is ADHD? <ul><li>Problems with Attention, Hyperactivity & Impulsivity </li></ul><ul><li>“ 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.” </li></ul>
  5. 5. What is ADHD? <ul><li>First described around 100 years ago </li></ul><ul><li>Also known as ADD, Hyperactivity, Hyperkinetic Disorder in UK (ICD-10) (more emphasis on Hyperactivity) </li></ul><ul><li>Problems of fine-tuning in the normal brain </li></ul><ul><li>Due to imbalance in neurotransmitters noradrenalin and dopamine in parts of the brain responsible for self-monitoring </li></ul>
  6. 6. What is ADHD? <ul><li>DSM-IV-TR - Three main subtypes: </li></ul><ul><ul><li>Predominantly Inattentive Type </li></ul></ul><ul><ul><li>Predominantly Hyperactive-Impulsive Type </li></ul></ul><ul><ul><li>Combined Type </li></ul></ul><ul><ul><li>ADHD not otherwise specified </li></ul></ul>
  7. 7. <ul><li>Hyperactivity/Impulsivity </li></ul><ul><ul><li>poor self-monitored behaviour. </li></ul></ul><ul><ul><li>always ‘on the go’, fidget, restless. </li></ul></ul><ul><ul><li>cannot sit still, doesn’t wait for others. </li></ul></ul><ul><ul><li>Impatient, always taking, difficulty delaying responses. </li></ul></ul><ul><li>Inattention </li></ul><ul><ul><li>poor concentration and attention to detail. </li></ul></ul><ul><ul><li>does not settle to anything, completing things. </li></ul></ul><ul><ul><li>poor ability to organise activities or to engage in tedious activities, or tasks requiring sustained mental effort. </li></ul></ul>Symptoms of ADHD
  8. 8. ADHD Impulsiveness Inattention Combined type Hyperactive- Impulsive type Inattentive type Hyperactivity 61% 30% 9%
  9. 9. Inattention <ul><li>Failure to pay close attention to details or making careless mistakes when doing schoolwork or other activities </li></ul><ul><li>Trouble keeping attention focused during play or tasks </li></ul><ul><li>Appearing not to listen when spoken to </li></ul><ul><li>Failure to follow instructions or finish tasks </li></ul><ul><li>Avoiding tasks that require a high amount of mental effort and organization, such as school projects </li></ul><ul><li>Frequently losing items required to facilitate tasks or activities, such as school supplies </li></ul><ul><li>Continued… </li></ul>
  10. 10. Inattention <ul><li>Excessive distractibility </li></ul><ul><li>Forgetfulness </li></ul><ul><li>Procrastination, inability to begin an activity </li></ul><ul><li>Difficulties with household activities (cleaning, paying bills, etc.) </li></ul><ul><li>Difficulty falling asleep, may be due to too many thoughts at night </li></ul><ul><li>Frequent emotional outbursts </li></ul><ul><li>Easily frustrated </li></ul><ul><li>Easily distracted </li></ul>
  11. 11. Hyperactivity-impulsive behaviour <ul><li>Fidgeting with hands or feet or squirming in seat </li></ul><ul><li>Leaving seat often, even when inappropriate </li></ul><ul><li>Running or climbing at inappropriate times </li></ul><ul><li>Difficulty in quiet play </li></ul><ul><li>Frequently feeling restless </li></ul><ul><li>Excessive speech </li></ul><ul><li>Answering a question before the speaker has finished </li></ul><ul><li>Failure to await one's turn </li></ul><ul><li>Interrupting the activities of others at inappropriate times </li></ul><ul><li>Impulsive spending, leading to financial difficulties </li></ul>
  12. 12. ADHD (Video) <ul><li>Video - 9 year old child with ADHD </li></ul>Video viewable from the module website.
  13. 13. <ul><li>ADHD is a common developmental disorder affecting 2-5% of school age children in UK </li></ul><ul><li>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 </li></ul><ul><li>No large scale adult epidemiological studies available </li></ul><ul><li>Boys are six times more likely to be referred for help than girls </li></ul><ul><li>True ratio in community about 3:1 </li></ul><ul><li>Boys tend to be more disruptive; girls tend to suffer more silently </li></ul>Prevalence of ADHD
  14. 14. Comorbidity ADHD Poor Language Skills (pragmatic skills/ comprehension / verbal fluency) Executive Function Impairment (planning / organising/ digit span/ following instruction etc.) Motor Coordination Behavioural & emotional Problems (ODD, CD,OCD, Depression) Inhibition Deficits (Behavioural & verbal self regulation)
  15. 15. Comorbidity <ul><li>Substance Use Disorders in Adults With ADHD </li></ul><ul><ul><li>Alcohol abuse (15%) </li></ul></ul><ul><ul><li>Alcohol dependence (41%) </li></ul></ul><ul><ul><li>Substance abuse (45%) </li></ul></ul><ul><ul><li>Substance dependence (31%) </li></ul></ul><ul><ul><li>Any abuse or dependence (69%) </li></ul></ul><ul><li>(Millstein, et al, 1997) </li></ul>
  16. 16. Comorbidity <ul><li>Mood and Anxiety Disorders in Adults With ADHD </li></ul><ul><ul><li>Major Depression (63%) </li></ul></ul><ul><ul><li>Dysthymia (23%) </li></ul></ul><ul><ul><li>Bipolar (17%) </li></ul></ul><ul><ul><li>Panic Disorder (11%) </li></ul></ul><ul><ul><li>Simple Phobia (12%) </li></ul></ul><ul><ul><li>Generalized Anxiety (21%) </li></ul></ul><ul><ul><li>Obsessive Compulsive Disorder (7%) </li></ul></ul><ul><li>(Millstein, et al, 1997) </li></ul>
  17. 17. <ul><li>Personality Disorders in Adults With ADHD </li></ul><ul><ul><li>Anti-social personality (22%) </li></ul></ul><ul><ul><li>Passive aggressive personality (19%) </li></ul></ul><ul><ul><li>Borderline personality (14%) </li></ul></ul><ul><ul><li>Histrionic personality disorder (11%) </li></ul></ul><ul><ul><li>Avoidant (Anxious) (11%) </li></ul></ul><ul><li> (Barkley et al, 1998) </li></ul>Comorbidity
  18. 18. Causes of ADHD <ul><li>The causes of ADHD are not fully known </li></ul><ul><ul><li>Likely to have multiple causes and complex interactions </li></ul></ul><ul><ul><li>Good evidence for genetic component </li></ul></ul><ul><ul><li>Evidence of structural and functional brain abnormality </li></ul></ul><ul><li>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). </li></ul><ul><li>Environment impacts on genes </li></ul>
  19. 19. DSM <ul><li>1980 – The name Attention Deficit Disorder (ADD) was first introduced in DSM-III, the 1980 edition. </li></ul><ul><li>1987 – The DSM-IIIR was released changing the diagnosis to &quot;Undifferentiated Attention Deficit Disorder.“ </li></ul><ul><li>1994 – DSM-IV described three groupings within ADHD, which can be simplified as: mainly inattentive; mainly hyperactive-impulsive; and both in combination. </li></ul>
  20. 20. <ul><li>Clear DSM criteria but reality is different – clinician’s judgement </li></ul><ul><li>The cut-off between normal-but difficult temperament and ADHD is not clearly definable </li></ul><ul><li>No single reliable test for ADHD </li></ul>Diagnostic Criteria for ADHD
  21. 21. <ul><li>Preschool and Kindergarten Years </li></ul><ul><ul><li>Very short attention span </li></ul></ul><ul><ul><li>Moodiness </li></ul></ul><ul><ul><li>Can’t listen long to stories </li></ul></ul><ul><ul><li>Motor-skill problems </li></ul></ul><ul><ul><li>Highly impulsive </li></ul></ul><ul><ul><li>Not interested in playing with other children </li></ul></ul><ul><ul><li>Poor self-control when frustrated or angry </li></ul></ul>Developmental Course of ADHD
  22. 22. <ul><li>Infancy and Toddler Years </li></ul><ul><ul><li>Irritability </li></ul></ul><ul><ul><li>Shrill, frequent crying </li></ul></ul><ul><ul><li>Overactive and restless </li></ul></ul><ul><ul><li>Sleep problems </li></ul></ul><ul><ul><li>Fussy eater </li></ul></ul><ul><ul><li>Difficulty adapting well to changes in the environment </li></ul></ul><ul><ul><li>Difficulty nursing and feeding </li></ul></ul>Developmental Course of ADHD
  23. 23. <ul><li>Primary School Years </li></ul><ul><ul><li>Typically diagnosed in primary school years </li></ul></ul><ul><ul><li>Falls behind in academic performance </li></ul></ul><ul><ul><li>Trouble following rules </li></ul></ul><ul><ul><li>Cannot sit quietly </li></ul></ul><ul><ul><li>Finds it hard paying attention </li></ul></ul><ul><ul><li>Difficulty working cooperatively or productively </li></ul></ul>Developmental Course of ADHD
  24. 24. <ul><li>Secondary School Years </li></ul><ul><ul><li>Academic difficulties (esp. literacy) </li></ul></ul><ul><ul><li>Challenge parents authority </li></ul></ul><ul><ul><li>Poor self-management </li></ul></ul><ul><ul><li>Poor time-awareness / lateness </li></ul></ul><ul><ul><li>Forgetfulness </li></ul></ul><ul><ul><li>Easily bored </li></ul></ul><ul><ul><li>Impulsive and irritable </li></ul></ul><ul><ul><li>Immaturity </li></ul></ul><ul><ul><li>High-risk behaviours </li></ul></ul>Developmental Course of ADHD
  25. 25. Developmental Course of ADHD <ul><li>Adult ADHD </li></ul><ul><ul><li>Difficulty with directions (98%) </li></ul></ul><ul><ul><li>Poor sustained attention (92%) </li></ul></ul><ul><ul><li>Shifting activities (92%) </li></ul></ul><ul><ul><li>Easily distracted (88%) </li></ul></ul><ul><ul><li>Losing things (80%) </li></ul></ul><ul><ul><li>Fidgeting (70%) </li></ul></ul><ul><ul><li>Interrupting (70%) </li></ul></ul><ul><li>(Millstein, et al, 1997) </li></ul>
  26. 26. <ul><li>Inattention and Hyperactivity impact on development generally </li></ul><ul><li>Some research characterises ADHD as a ‘developmental lag’ </li></ul><ul><li>The symptoms of ADHD lead to a vast number of negative consequences and high comorbidity </li></ul>Consequences of ADHD
  27. 27. Consequences of ADHD <ul><li>Follow-up studies of clinical samples suggest that sufferers are far more likely than normal people to: </li></ul><ul><li>Drop out of school (32–40%), to rarely complete college (5–10%). </li></ul><ul><li>Have few or no friends (50–70%). </li></ul><ul><li>Under perform at work (70–80%). </li></ul><ul><li>To engage in antisocial activities (40–50%). </li></ul><ul><li>To use tobacco or illicit drugs more than normal. </li></ul>
  28. 28. Consequences of ADHD <ul><li>Moreover, children growing up with ADHD are more likely to experience: </li></ul><ul><li>Teen pregnancy (40%). </li></ul><ul><li>Sexually transmitted diseases (16%). </li></ul><ul><li>To speed excessively and have multiple car accidents, to experience depression (20–30%). </li></ul><ul><li>Personality disorders (18–25%) as adults. </li></ul>
  29. 29. <ul><li>ADHD is a disorder that persists across the lifespan </li></ul><ul><li>Most children are first diagnosed around primary school-age ( ≥ 7 years) </li></ul><ul><li>A trend away from hyperactivity towards inattention as the child develops </li></ul><ul><li>About 60-70% of those diagnosed in childhood carry symptoms into adulthood </li></ul>Lifespan of ADHD
  30. 30. Industry of ADHD
  31. 31. Controversy surrounding ADHD <ul><li>“ No mental disability this decade has been assailed by as much criticism, scepticism and flat out mockery as ADHD.” Mathew Cohen </li></ul><ul><li>Ritalin Debate (…to medicate or not to medicate?) </li></ul><ul><li>The concept of ADHD is said to be controversial but this is mainly due to the media and disagreement on treatment </li></ul><ul><li>International Consensus Statement on ADHD (2002) </li></ul><ul><ul><li>Available from web site (Seminar) </li></ul></ul>
  32. 32. Any Questions?
  33. 33. Group Seminars (For campus-based students) <ul><li>Group meetings for discussion, debate, workshop activities, videos and looking at research papers/publications. You’ll be expected to do academic reading for these. </li></ul><ul><li>Seminar group allocations on the Forum. </li></ul>Group Seminars (For distance-learning students) <ul><li>Online activities and Forum discussions of academic papers. You’ll be expected to do academic reading for these. </li></ul>

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