AAA Section 02 ADHD and Hyperkinetic Disorder Ver 04 2013

ADHD and
Hyperkinetic

UNDERGRADUATE
Disorder

Lecturer: Simon Bignell ‘Autism, Asperger’s & ADHD’ (6PS055) 1
Section: 2 of 11 ‘ADHD, Autism & Asperger’s’ (6PS077) 31

Introduction to the Section
• Symptoms of ADHD
– Inattention

UNDERGRADUATE
– Hyperactivity/Impulsiveness
• Prevalence
• Comorbidity
• Developmental course of ADHD
• Consequences of ADHD
• Lifespan
• Controversy


Learning Outcomes of this Section
On completion of the Section and with independent
study you should be able to:

UNDERGRADUATE
1. 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.


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.”

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


What is ADHD?

• DSM-IV-TR - Three main subtypes:

UNDERGRADUATE
– Predominantly Inattentive Type

– Predominantly Hyperactive-
Impulsive Type

– Combined Type

– ADHD not otherwise specified


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.


ADHD
Hyperactivity

Inattention

Inattentive Combined Hyperactive-
type type Impulsive type
30% 61% 9%

Impulsiveness

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…


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


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 one's turn
• Interrupting the activities of others at inappropriate times
• Impulsive spending, leading to financial difficulties


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


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

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%)


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%)

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%)


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


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.


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


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


• 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

• 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

• 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


• Adult ADHD

UNDERGRADUATE
– Difficulty with directions (98%)
– Poor sustained attention (92%)
– Shifting activities (92%)
– Easily distracted (88%)
– Losing things (80%)
– Fidgeting (70%)
– Interrupting (70%)

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


Follow-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.


Moreover, 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.


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

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)


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.


AAA Section 02 ADHD and Hyperkinetic Disorder Ver 04 2013

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AAA Section 02 ADHD and Hyperkinetic Disorder Ver 04 2013