adhd.pdf

ž Hyperactivity ¡ vs ADD vs ADHD Evolving conceptualization shifts emphasis ž Now collapsed into single entity ž A. A persistent pattern of inattention and/or hyperactivity- impulsivity that interferes with functioning or development, as characterized by (1) and/or (2) 1. Inattention: Six (or more)...

ž Hyperactivity ¡ vs ADD vs ADHD Evolving conceptualization shifts emphasis ž Now collapsed into single entity ž A. A persistent pattern of inattention and/or hyperactivity- impulsivity that interferes with functioning or development, as characterized by (1) and/or (2) 1. Inattention: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities: ¡ ¢ Note: The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or failure to understand tasks or instructions. For older adolescents and adults (age 17 and older), at least five symptoms are required. a.Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details, work is inaccurate) b.Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading) c.Often does not seem to listen when spoken directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction) d.Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked) e.Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganized work; has poor time management; fails to meet deadlines) f.Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers) g.Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones) h.Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts) i.Is often forgetful in daily activities (e.g., doing chores, running errands; for older adolescents and adults, returning calls, paying bills, keeping appointments) 2. Hyperactivity and impulsivity: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities: ¡ ¢ Note: The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or a failure to understand tasks or instructions. For older adolescents and adults (age 17 and older), at least five symptoms are required a. Often fidgets with or taps hands or feet or squirms in seat b.Often leaves seat in situations when remaining seated is expected (e.g., leaves his/her place in the classroom, in the office or other workplace) c.Often runs about or climbs in situations where it is inappropriate (Note: in adolescents or adults, may be limited to feeling restless) d. Often unable to play or engage in leisure activities quietly e.Is often “on the go,” acting as if “driven by a motor” (e.g., in unable to be or uncomfortable being still for extended time, as in restaurants, meetings, may be experienced by others as being restless or difficult to keep up with) f.Often talks excessively g.Often blurts out an answer before a question has been completed (e.g., completes people’s sentences; cannot wait for turn in conversation) h.Often has difficulty waiting his or her turn (e.g., waiting in line) i.Often interrupts or intrudes on others (e.g., butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission; for adolescent and adults, may intrude into or take over what others are doing) B.Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years C.Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (e.g., at home, school, or work; with friends or relatives; in other activities) D.There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning E.The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal) § Specify whether: § § § Combined presentation: If both Criterion A1 (inattention) and Criterion A2 (hyperactivityimpulsivity) are met for the past 6 months Predominantly inattentive presentation: If Criterion A1 is met but Criterion A2 is not met for the past 6 months Predominantly hyperactive/impulsive presentation: If Criterion A2 is met and Criterion A1 is not met for the past 6 months § Specify if: In partial remission Specify current severity: § Mild, Moderate, Severe § § Language, motor, and social development delays Low frustration tolerance, irritability, or mood lability May exhibit cognitive problems on tests of attention, executive function, or memory Increased risk of suicide Academic or work performance Associated with various underlying cognitive processes Common Functional impairments Not specific to ADHD Especially if comorbid mood, conduct, or substance use disorder No biological marker is diagnostic for ADHD Increased slow wave electroencephalograms, reduced total brain volume on MRI, possibly a delay in posterior to anterior cortical maturation Findings are not diagnostic Level of dysfunction may vary From setting to setting Within settings at different times Typically occur/worsen in certain situations: Group situations E.g., play groups, classrooms Require sustained attention or mental effort Lack intrinsic appeal or novelty Signs may be minimal or absent at times Therefore, necessary to gather information from multiple sources (e.g., parents, teachers) and inquire about behavior in a variety of situations in each setting (e.g., homework, meals) ž Inattentive dimension of ADHD-I may be associated with a different set of inattentive behaviours than those associated with ADHD-C ¡ Characterized by: ¢ ¢ ¢ ¢ ¢ ¢ ¢ ¢ Difficulty sustaining attention Daydreaming Lethargy Mental confusion or mental fogginess Low motivation/initiation Physical underactivity Slowed movement Decreased responsiveness Often described as spacey, have slowed information processing, easily confused, erratic retrieval of information from memory, being socially reticent and uninvolved, hard to wake in the morning ž Rarely aggressive and less likely to have ODD or CD ž However, there are unique components of SCT (lethargy, underactivity, and slowness) which appear distinct from the inattention associated with ADHD ž ¡ Medications not as effective, as they target hyperactive/impulsive symptoms better than SCT ž ž 30-35% of first degree relatives of children with ADHD also have the disorder Heritability of 70-80% ¡ ž Little or no evidence that environmental risk factors significantly impact etiology Genes that affect the dopamine pathway, due to the mechanism of action of psychostimulant medication ¡ Multiple genes have been found linked to ADHD ¢ ž ž Strong influence of genetic factors of levels of hyperactivity, impulsivity Most of the genetic variance in ADHD symptomatology remains unexplained Higher prevalence of mood and anxiety disorders, learning disorders, substance use disorders, and antisocial personality disorder in family members of individuals with ADHD ž Prematurity ¡ Low birth weight (