This document provides an overview of ADHD, including that it is the most common neurodevelopmental disorder, affecting approximately 5% of children and 2.5% of adults worldwide. It discusses the history of ADHD and evidence that it has been recognized as far back as the late 18th century. The document also summarizes research showing differences in brain activation patterns between those with and without ADHD. In addition, it outlines the diagnostic criteria for predominantly inattentive and hyperactive/impulsive presentations in the DSM-5 as well as high rates of comorbidity with conditions like depression, anxiety, substance abuse, and psychosocial dysfunction. The document concludes with a discussion of comprehensive treatment approaches including medication management, behavioral therapies

1. ADHD
It’s more than inattention
and hyperactivity

2. Agenda
• Introduction
• ADHD Overview
• Diagnosis
• Treatment

3. Roseann Bennett
Licensed Marriage and Family Therapist
Lic# 37FI00162800

4. Prevalence
• Most common neurodevelopmental disorder
• Approximately 5.3% of children worldwide meet
diagnostic criteria for ADHD (Polanczyk et al., 2007)
• Approximately 2.5% of adults suffer from ADHD
(SImon et al., 2009).

5. History
• ADHD is not new (although it is relatively new to the
DSM).
• There is evidence of ADHD as far back as 1798 by Sir
Alexander Crichton who published a work, On Attention
and its Diseases
• Also evidence in 1844 Fidgety Phil was introduced.
http://germanstories.vcu.edu/struwwel/zappel1.gif

6. Brain Disorder
• http://www.ucdmc.ucdavis.edu/welcome/features/20071128_mind_adhd/

7. Brain Disorder Cont…
Age Group
Regions associated
with over activation
Regions associated
with under activation
Children and
Adolescents
-Right angular gyrus
-Middle occipital gyrus
-Posterior cingulate
cortex
-Midcingulate cortex
-Frontal regions
(bilaterally)
-Putamen (bilaterally)
-Right parietal region
-Right temporal region
Adults
-Right angular gyrus
middle occipital gyrus
-Right central sulcus
precentral gyrus
-Middle frontal gyrus
*Activation patterns in the brain as indicated by a meta-analysis of 55 fMRI studies

8. According to the DSM5….
• This list is not exhaustive, but gives a broad picture
• Predominately Inattentive
• Often has difficulty sustaining attention on tasks
• Often has difficulty organizing tasks or activities
• Often does not follow through with instructions
• Often loses things that are necessary for certain
tasks

9. DSM continued
• Predominately hyperactive/impulsive
• Often fidgets or squirms in seat
• Often talks excessively
• Often has difficulty waiting his/her turn
• Often blurts out answers before a question is completed
• Often “on the go” or appears driven by a motor
• Combined Presentation
• Symptoms have to be present for at least 6 months

10. Comorbidity
• Depression
• Anxiety
• Substance Use
• Psychosocial dysfunction

11. Depression
• Major Depressive Disorder is the most commonly
comorbid condition associated with ADHD as a
whole and is associated with a poorer outcome than
either disorder alone (Spencer, Wilens, Biederman,
Wozniak, & Harding-Crawford, 2000).

12. Anxiety
• Highly comorbid condition of ADHD
• 47.1% meet criteria for some type of anxiety
disorder (Fisher et. al., 2007).

13. Substance Use
• They found that both inattentive and
hyperactive/impulsive types of ADHD were
associated with increased risk of substance
dependence, however hyperactive/impulsive type
was at greater risk
• The relationship between substance use and ADHD
is linear; each additional ADHD symptom was
generally associated with a proportional increase in
odds of substance dependence

14. Smoking
• Individuals with ADHD are more likely to become
regular smokers (Pomerleau et al.,1995), and they
tend to start smoking earlier and smoke more
heavily (Kollins, et al., 2005; Lambert & Hartsough,
2000).
• Severity of smoking is also directly proportional to
the severity of ADHD symptoms endorsed (Lambert
& Hartsough, 2000).

15. Psychosocial Dysfunction
• Driving
• Experience more automobile accident crashes, experience
more bodily injury and more at-fault determinations, than do
non-ADHD counterparts, with those with ADHD and ODD
and/or CD at greatest risk
• One study showed that sober adults with ADHD exhibited
decrements and that the profile of impairment for the sober
ADHD group did, in fact, resemble that of intoxicated
drivers at the blood alcohol level for legally impaired driving
in the United States (Weafer et al., 2008).

16. Psychosocial Dysfunction
cont…
• Academic deficits, school-related problems, and
peer neglect tend to be most associated with
elevated symptoms of elevated inattention in
children whereas peer rejection are more closely
related to peer rejection (Willcutt et. al., 2012).

17. Not exhaustive
• ADHD interferes with nearly every aspect of
functioning.
• Parents of ADHD children are more likely to divorce
(Wymbs et. al., 2008), those with ADHD have poor
occupational outcomes (Young, 2010), and may
have an increased risk to suicide (Ljung, et.al,
2014).

18. Diagnosis
• Rule out/Consider
• Intellectual Functioning
• Learning Disorder
• Mood/Personality/Other Mental Illness
• Auditory Processing

19. Diagnosis cont…
• Examples of some tools that we use
• BASC3
• WISC5/WAIS IV
• K-TEA3
• Quotient ADHD System
• BYI-II
• ADHDT-2
• MMPI-2/MCMI IV
• Comprehensive history
• Semi-Structured Clinical Interview

20. Treatment
• Medication insufficient for comprehensive treatment
• Behavior Therapy
• Time management
• Getting organized
• Cognitive Behavior Therapy
• Exercise (Halpern., 2011)
• www.div12.org

21. Time Management and
Getting Organized
• Awareness and scheduling
• Making tasks manageable
• Prioritizing and to-do lists
• Overcoming emotional obstacles
• Activation and motivation
• Setting up, implementing, and maintaining an
organizational system

22. Exercise
• Walking 30 minutes a day x4 a week, has shown
marked improvement
• Taw Kwon Do, Ballet, Gymnastics- extreme focus
on body movement

23. Misconceptions
• My child’s medication was effective, therefore they
must have ADHD
• Sugar = hyperactivity
• Having ADHD does not entitle my child to special
services or as an adult, does not cover me under
the ADA.
• My child just wants attention

24. Resources
• http://www.chadd.org
• http://www.additudemag.com/
• http://add.org
• www.apa.org
• http://idea.ed.gov