A PowerPoint about adhd

1. All About ADHD

2. • Tonight’s topics:
– ADHD Child Assessment and Diagnosis –
• Janine Hubbard, PhD., R. Psych.
– Parenting and ADHD
• Lorna Berndt Piercey, M.Sc., R. Psych.
– Medication Options in ADHD
• Kim St. John, MD.
– ADHD in Adults
• Bev McLean, M.Sc., R. Psych.
– ADHD in post secondary settings and ADHD strengths
• Lisa Moores, PsyD., R. Psych.
– Questions and discussion
All about ADHD

3. ADHD Child Assessment and
Diagnosis
Janine Hubbard, PhD., R. Psych.

4. Background
• Neurodevelopmental disorder
• Most prevalent childhood psychiatric disorder
in Canada
• Occurs in approximately 5% of children (some
est. as high as 12%)
• Strong genetic component
• Persists into adulthood

5. Background
• Problem with regulation of attention, not just
inattention
• Can present as over-focused (esp. when very
interested)
• Difficulty refocusing/transitioning from one
activity to another
• Attention levels may fluctuate from day to day
(even for same tasks)

6. Background
• Not diagnosed prior to age 6
• Symptoms present before age 12
• Symptoms present in two or more settings
• Symptoms interfere with functioning
• Not otherwise explained by underlying
medical or psychiatric disorder

7. Types of ADHD (DSM-V)
• Predominantly Inattentive (previously ADD)
• Predominantly Hyperactive/Impulsive
• Combined

8. Inattentive Presentation
• fails to give close attention to details or makes careless
mistakes
• has difficulty sustaining attention
• does not seem to listen when spoken to directly
• does not follow through on instructions and fails to finish
tasks
• has difficulty organizing tasks and activities
• dislikes or avoids tasks that require sustained mental effort
• loses things necessary for tasks or activities
• is often easily distracted (either external distraction or
internal thoughts)
• forgetful in daily activities

9. Hyperactive/Impulsive Presentation
• fidgets, taps hands or feet, squirms in chair
• leaves seat inappropriately
• runs about or climbs in inappropriate situations
• unable to play quietly
• difficulty staying still for long periods of time (“on the go”
“driven by a motor”)
• talks excessively
• blurts out answers before question has been completed
• difficulty waiting his or her turn
• interrupts or intrudes on others (conversations, belongings,
activities)

10. ADHD in Girls
• Est. 3:1-2:1 ratio of males:females
• Girls often diagnosed later
• Symptoms often confused with anxiety and
depression
• Inattentive presentation more common
• Highly intelligent girls less likely to be diagnosed
• Symptoms of mood swings, anxiety and
depression often increase in adolescence

11. Differential Diagnosis:
What Else Could It Be?
• Anxiety
• Depression
• OCD
• Learning issues
• Above average/below average intelligence
• Expressive/receptive language difficulties

12. Differential Diagnosis:
What Else Could It Be?
• History of trauma
• Family issues
• Sleep issues
• Vision/hearing problems
• Medication side effects

13. Psychological Assessment
• Cognitive abilities
• Academic achievement
• Memory
• Attention/concentration
• Executive functioning
• Behavioural/emotional functioning
• Review of report cards, parent interview,
developmental history

14. Cognitive Abilities
• Verbal reasoning
• Visual-spatial skills
• Fluid reasoning
• Working memory
• Processing speed

15. Academic Achievement
• Gaps/inconsistencies in achievement
• Academic fluency
• Sustained attention
• Careless/inattentive errors
• Assess for potential specific learning disorder

16. Memory
• Auditory vs visual memory skills
• Short term vs long-term memory skills

17. Attention/Concentration
• Auditory vs visual attention
• Brief vs sustained attention
• Dual attention

18. Executive Functioning
• Inhibition
• Shift
• Initiation
• Working memory
• Planning/organizing
• Organization of materials
• Self-monitoring

19. Behavioural/Emotional Functioning
• Measures of home/school/self-report
• General screen of behavioural/emotional
functioning
• Attention specific questionnaires
• Age/gender normed

20. Thank you!

21. Parenting and ADHD
Lorna Berndt Piercey, M.Sc., R. Psych.

23. Main Features of ADHD

24. InATTENTION
• difficulty changing activity
• hyperfocusing
• losing things
• not putting things away
• homework

25. IMPULSIVENESS
• interrupting
• acting “without thinking”
• dangerous or destructive actions

26. HYPERACTIVITY
• fidgeting
• intense reactions
• always moving
• difficulty being quiet when necessary

29. FAMILY DECISION
• decide on specific goals
• discuss these with your child
• work out a plan for each goal;
your aim is to make the desired
behaviour a habit
• do not add more goals too quickly

30. WHAT DOESN'T WORK
• ranting
• “distant” punishments
• warnings about future dire
consequences
• getting pulled into arguments
• lectures
• getting “the last word”

31. WHAT HELPS
• noticing and acknowledging positive
behaviour
• consistent expectations
• consistent consequences
• solving problems together

32. WHAT HELPS
• practical solutions
• noticing when your child is overtired
and losing control
• remembering that there is a
physiological reason for your child's
behaviour
• parental breaks

33. Medication Options in ADHD
October 2017
APNL
Kim St. John, MD.

34. Objectives
• Look at the role of medication in ADHD
• Review the common medications, including
side effects
• Review options when first line medications
don’t work

35. Why?

36. • Medication alone is more effective than
behavioural therapy
• Combination therapy is more effective than
behavioural therapy or medication alone in
things like school performance, parent child
relationships and social skills
• Biggest reason behavioural therapy doesn’t
work is impulsivity

37. Options
• Stimulants
• others

38. Stimulants
• First line
• Safe
• Well tolerated
• Increase arousal centrally

39. Two groups
• Methylphenidate
– Ritalin IR
– Ritalin SR
– Biphentin
– Concerta
• Dextro-amphetamine
– Dexedrine
– Dexedrine Spansules
– Adderal XR
– Vyvanse

40. Methylphenidate-based
• Blocks reuptake of dopamine

42. Dextro-amphetamine based
• Blocks the reuptake of dopamine
• Increases release of dopamine and
noradrenaline

44. Common Side Effects
• Decreased appetite
• Trouble getting to sleep
• “unmask” tics
• Mood symptoms
• Increased anxiety
• Headaches
• Rebound hyperactivity
• Slight BP and pulse increases

45. • Sudden death-rare

46. How to choose?
• Family history
• Medical history
• Most times doesn’t matter

47. Cost
Long acting are generally more expensive but
covered by NLPDP, special authorization
Most private insurances cover Concerta
Some cover Vyvanse

48. Long acting best
• No peaks and troughs
• Longer action- single dose, no medication at
school
• Less diversion
• Biggest role for short acting is top up (end of
day or to help kick in )

50. Dextro-amphetamine related

51. Vyvanse
• Prodrug
• Longest acting (13-14 hours)
• Capsules can be opened and dissolved
• No abuse potential

52. Adderall XR
• 10-12 hours
• Can be opened and beads sprinkled
• 50% immediate/50% longer

53. Dexedrine Spansules
• 6-8 hours
• Can be sprinkled

54. Methylphenidate based

55. Concerta
• 10-12 hours
• Can’t be crushed/ dissolved
• 28% short acting/72% long acting

56. Biphentin
• 10-12 hours
• 40% immediate/60% gradual
• Can be opened and sprinkled

57. Immediate release
• Ritalin
• Dexedrine
• Best used for
– top up
– to help with speed of onset

58. Strattera (atomoxetine)
• Specific noradrenaline reuptake inhibitor
• Limited abuse potential
• Helpful for overnight
• Can’t be opened
• Stomach upset

59. Intuniv XR (guanfacin XR)
• Alpha 2A adrenergic receptor agonist
• Continuous coverage
• ?Tic disorders
• Side effects: sedation, sleepiness, decrease in
blood pressure and pulse
• Takes long time to work, must be weaned off
• Adjunct with stimulant

61. References
• The MTA Cooperative Group: A 14-month
randomized clinical trial of treatment strategies
for attention deficit/ hyperactivity disorder
(ADHD). Arch Gen Psychiatry 1999;56:1073-1086
• The MTA Cooperative Group: Moderators and
mediators of treatment response for children
with attention Deficit/hyperactivity disorder
(ADHD). Arch Gen Psychiatry 1999;56:1088-1096
• Canadian ADHD Resource alliance (CADDRA)
Canadian ADHD Practice Guidelines, third edition,
Toronto ON;CADDRA 2011

62. ADHD in Adults
Bev McLean, M.Sc., R. Psych.

63. ADHD in Adults
• 65%-75% of children diagnosed with ADHD will
exhibit symptoms into adulthood
• Adults often present for assessment when they are
–struggling with post-secondary education,
–having difficulty keeping a job,
–experiencing relationship difficulties,
–or when a child is diagnosed
• Untreated ADHD in adults can be disabling

64. ADHD in Adults
• Distracted by external events or internal thoughts - mind
racing
• Trouble paying attention over time, especially with tasks
that are difficult or boring
• Hyper focusing and being unable to refocus attention on
more important things, especially when involved in
activities that are stimulating
• Difficulty prioritizing attention based on importance rather
than interest
• Impulsivity - spending, speeding, making impulsive decisions
• Restless, fidgety, excessive talking, seeking high risk
activities

65. ADHD in Adults
• Disorganization, procrastination, leave a mess
everywhere
• Emotional, hypersensitive, low frustration
tolerance
• Quick temper, impatient
• Difficulty staying motivated

66. ADHD in Adults
• Difficulty managing stress, easily
overwhelmed
• Unemployment
• Chronic sense of underachievement
• Loneliness/Social difficulties
• Self medication

67. • Altered Sense of Time
• Poor time management, late, rushing
• Forgetful
• Loses things
• Difficulty starting/finishing tasks
ADHD in Adults

68. Hyperactivity 4 Restlessness
Can’t sit still/always on the go 4 Workaholic,
over scheduled
Climbs or runs at inappropriate times 4 Is
fidgety, impatient, internally restless,
Childhood vs. Adult Symptoms

69. Childhood vs. Adult Symptoms
Physical Impulsivity 4 Verbal Impulsivity
Does things that cause injury 4 Says
inappropriate things
Difficulty waiting turn 4 Excessive interrupting

70. Childhood vs. Adult Symptoms
Inattention 4 Inattention
Excessive difficulty paying attention in class
or finishing school work or homework 4
Excessive difficulty concentrating at work or finishing work tasks,
or spends an inordinate amount of time completing work tasks,
working overtime to meet deadlines

71. Adults with untreated ADHD
• More than twice as likely to have been arrested
• 2-4x as likely to be in a motor vehicle accident
• 78% more likely to be addicted to tobacco
• Twice as likely to have been divorced
• More than twice as likely to have dropped out of high
school
• Twice as likely to have held 6 or more jobs in the last 10
years

72. • Similar to children, use of Adult rating scales,
psychological tests, history taking, partner
and/or parents
• Important to rule out medical causes - see
your doctor
• Important to assess for co-existing disorders:
Learning Disability, Anxiety, Depression,
Substance Use Disorder
Diagnosis

73. On the Bright Side
• Numerous treatment options
– Medication
– Behaviour Therapy
– Coaching

74. On the bright side
• Often do well with external support
• “External organizer”
• Spouses/Partners may need to reassess
view of ADHD behaviours

75. ADHD in Post-Secondary Settings
Lisa Moores, PsyD., R. Psych.

76. • It’s not rare
• Approximately 2 to 8% of the college
population has ADHD
• One study found 7.48%, with 20%
approaching ADHD diagnostic requirements
• At least 25% of college students with
disabilities are diagnosed with ADHD
What we know…

77. Existing
ADHD
Emerging
ADHD
Students
with
ADHD

78. I didn’t know what it was. I found it very
distressing. I knew I couldn’t do the things that
normal people could do. I had the ability to do
it but I just couldn’t do it. I found it very
frustrating.
The lived experience

79. I got so angry with myself because I used to
go to bed at night and think ‘Tomorrow I’m
going to be really good’ but I actually didn’t
know what I was doing wrong.

80. Until I knew about this condition, I assumed
that everything was part of my personality.
And I guess one of the things it gives you is
an awareness of how many things that you
convince yourself are conscious decisions are
in fact nothing of the kind.

81. In one part of me I felt elated. It was almost
like, ‘Oh there’s an actual reason why I acted
like that.’

82. ADHD
Impacts
Academic
Adulting
Health
Relationships
Where does ADHD “show up”?

83. Strategize
• Learn how to “do” ps first
• Seek accommodations
• Fill in the gaps
Create
structure
• Develop routines
• Invest time in making organization automatic
Use Tools
• Take advantage of technology
• Research options
Managing Academic Impact

84. Money
• Learn about finances
• Ease into financial independence
• Use technology to your advantage
Housing
• Living environment impacts ADHD
• Consider pros and cons
Organization
• Skill that is learned
• Use technology
Managing Adulting Impact

85. Disclosure
• A personal choice
• Not all or nothing
Reflect
• Feedback from trusted others
• Know your strengths and weaknesses
Social
Priorities
• Prioritize maintaining and developing relationships
• Expand your social support network
Managing Relationship Impact

86. Basic Needs
•Protect sleep
•Nourish your body
•Maintain healthy coping
Health Team
•Develop relationships with health pros
•Stay on top of medication treatment
•Be proactive
Substance Use
Awareness
•Understand how substance abuse impacts ADHD and medication
•Be vigilent
Managing Health Impact

87. ADHD Strengths

88. Are there any advantages to
having an ADHD brain?

89. Let’s turn the symptoms on their
heads

90. Attention Dysregulation
NOT Deficit
Hyperfocus
Inspiration
Notice what others
miss
Able to attend to and
work with large
volumes of information
Inattention

91. Fearless
Passionate
Spontaneous
Fun
Fresh perspectives
Pushing limits
Honest
Intuitive
Impulsivity

92. ENERGY!!!
Active bodies and
minds
Fast thinkers
Enthusiastic
Resourceful
Motivated
Hyperactivity

93. ADDled Overachievers
Wall of Fame

94. Justin
Timberlake
Jamie Oliver Lisa Ling
Adam Levine

95. Richard
Branson
Michael Phelps Simone Biles
Whoopi
Goldberg

96. Thank You!! 
Questions?