ADHD (Attention Deficit Hyperactivity Disorder)

Jillian Donna Tabitha

What is ADHD?

• ADHD- a condition that can cause trouble with focus, patience, and over-activity.

• One of the most common childhood disorders.• Dr. Heinrich Hoffman- 1845 (first discovered)• 1902- characteristics first really studied• People with ADD have trouble focusing and

concentrating, but are not hyperactive or impulsive like with ADHD.

• Boy to Girl Ratio: ADD-2:1 ADHD-4:1

Causes

• According to the book, “An imbalance between the left and right sides of the prefrontal cortex and abnormal growth of the corpus callosum seem to underlie (and perhaps cause) ADHD.”

• Causes symptoms to worsen: Eating too much sugar, Watching a lot of television, Parenting styles, Social and environmental issues like poverty or family chaos

Symptoms

• There are three different types of ADHD-• Inattentive- impaired attention and

concentration• Hyperactive- hyperactivity without

inattentiveness • Combined- involves all symptoms

Symptoms Continued• Inattentive ADHD symptoms may include-• Difficulty paying attention to details which causes

careless mistakes.• Inability to sustain attention on tasks or activities• Easily distracted by irrelevant things and frequently

interrupts ongoing tasks. • Difficulty finishing tasks that require concentration and

shifting from one activity to another without finishing the first

• Procrastination and disorganization• Forgetfulness and failure to complete daily activities

Symptoms Continued

• Hyperactivity-• Fidgeting and getting up frequently• Having difficulty playing quietly• Often talking excessively• Impulsivity-• Impatience and having difficultly waiting for questions

to be completed before answering• Difficulty awaiting one's turn• Frequently interrupting conversations and starting

conversations at inappropriate times

Diagnosis/Controversy

• There is no single medical, physical, or other test for diagnosing ADD/ADHD.

• Medical professionals use a checklist of symptoms, ask questions about past and present problems, or a medical exam to figure out if someone does have ADD or ADHD.

• ADD/ADHD looks different in every person, so there are different ways to measure and ways to test to help doctors reach a diagnosis.

• In Medicating Children, Rick Mayes said “Where the boundary between ADHD and typical childhood behavior is located is ultimately a political and social choice, not a scientific one”

• Increase in Diagnosis and increase in medication treatment

State-based Prevalence Data of ADHD Medication Treatment (2003)

State-based Prevalence Data of ADHD Diagnosis (2007-2008)

Side effects of Medicine

• Effects on Motor Activity and Coordination-• Reduced activity level to normal, improved handwriting

and neatness and improved fine motor control• Cognitive Effects-• Decreased impulsivity and distractibility and increased

production and accuracy of work• Effects on Social Behavior-• Decrease in anger, bossy behavior, and verbal and

physical aggression. Also it improves participation in organized activities.

Effects of Schooling• “Studies found that students with ADHD, compared

to students without ADHD, had persistent academic difficulties that resulted in the following: lower average marks, more failed grades, more expulsions, increased dropout rates, and a lower rate of college undergraduate completion”

• “Difficulty sustaining attention to a task may contribute to missing important details in assignments, daydreaming during lectures and other activities, and difficulty organizing assignments”

Effects of Schooling Cont. Diagnosed Attention Deficit Hyperactivity Disorder and Learning Disability: United States, 2004-2006

Treatments

• 5 behavior modification methods: • Cognitive-behavioral interventions- role playing and verbal ques

(wasn’t proven effective) • Clinical behavior therapy- teaching parents/teachers how to

manage children with ADHD • Direct contingency management-rewards and consequences,

specialized classrooms• Intensive packaged behavioral treatments- 8 week summer camp

(2 hrs. classroom, rest of day recreational), progress tracked by parents

• Combined behavioral and pharmacological treatments- (BEST METHOD) use medications and behavioral methods.

Childhood vs. Adulthood

• ADHD symptoms can be more subtle in adults than in children• 60% of children with ADHD may continue to have symptoms as

adults• “Signs of ADHD like fidgeting, hyperactivity, excessive talking

and interrupting and intruding on others are usually more obvious in ADHD kids because they have fewer social constraints limiting their behavior. Adults with ADHD are likely to show more restraint due to their higher level of maturity and social conditioning, but the inner restlessness remains and may be re-channeled into activities like thrill-seeking behavior, alcohol, drug abuse, reckless driving, incursions with the law, overspending and other socially unacceptable behaviors.”

Mother interview• 1. What differences do you notice in behavior between the ADHD child and

normal children? Biggest difference attention span. Also, with ADHD children you have to break down the tasks and micro-manage.

• 2. How do the other kids interact with the ADHD child? They get frustrated with him . Some days are better than others, so he is unpredictable. The environment can affect his mood.

• 3. What do you have to do differently parenting? Have to break things down because he can only handle one task at a time. For instance, I can’t tell him to go get ready for bed and list off the things he has to do. I have to give him one task at a time, then check with him to give him the next task.

• 4. How much does it cost for medication and doctor visits? Costs- Medication- $140 monthly, every six months he has to got to a neurologist

• 5. How much do you think ADHD affects their schooling? It totally affected his schooling. We pulled him out of public school. The class size was too big. He didn’t fall into special ed. , but he couldn’t keep up with everyone else.–dependent on parents. I volunteered to help in his class and was able to see his needs. When he was in a smaller class he did much better. His grades went up.

Mother interview cont.• 6. Does it put extra stress on the family and how much? Yes, there was more

stress in family. With a big family, everyone needs to be patient and realizing he is different. It’s not necessarily the adhd. It’s just that it is different and they don’t have it so it’s harder for them to understand. If it was anything else they would still need to learn how to deal with it.

• 7. What are some side effects from the medicine that you’ve noticed? The generic brand caused side effects. Also, it’s important to find the right dosage. Some days he’s in a fog. She can tell the difference between not paying attention and the effects of the drug. His appetite gets suppressed and then when he was off he ate a lot to make up for it. When they took him completely off his appetite was back to normal.

• 8. Anything else you’ve noticed that you think we should know? It’s important to educate the child of what is happening to him. To talk about what strategies are working, why he is different, to have him articulate what he is feeling and to talk about the differences when he does and doesn’t take his medication. It was frustrating for him because he knew something was different but did not know how to control it. Parents need to be open with their children with whatever choice, medication or brain therapy program, they choose. The extent to which they explain it should be age appropriate. Include them in their medical care.

Patient Interview• How do you think ADHD affects your schooling? Without meds (same

throughout) - didn’t grow out of it. Last semester I wasn’t on meds for half the semester (after mission process) The days would go by so fast. I learned nothing. One concept would take 5 hours when it seemed like 1. On med I would get 10 concepts down in the same amount of time. Seems like when not on meds and I try studying and be trying to learn and before I know it I’m already thinking of something else. Started meds at 4th grade. 4.0 On meds. Off meds failing two classes had a c in one class (basically horrible in everything). On meds can focus and retain more. 2nd floor of the library with someone talking about cool stuff in your ear the entire time and can’t go away while trying to study, impossible.

• How was it on mission? I was allowed to have meds but I stopped taking it my senior year of high school because I thought I didn’t need it. So I went on my mission without it. I thought I was a good missionary. I was always a go go go missionary, not enough time in the day. Always trying to fix peoples problems. So I never wanted to waste time. If I was on my meds I would’ve thought about taking a time out and letting the investigator feel comfortable while working on problems.

Patient Interview Cont. • Are there any side effects of the medicine? Does it Alter your mood?

Yeah. The med is a psychostimulant. Its Adderall, dextroamphetamine. Ingredients are the same as meth. Phenylethilamine. It’s single methylated Phenylethilamine. It is made in a slightly different process than meth. It raises your heart rate. The good thing is that doctors monitor you to figure out your proper dosage so you have what you want without the bad side effects. Overdoses causes the same effects as meth (super excited). It’s like feeling accomplished when finishing a hamburger, but once the drug wears out you feel worse (rebound). Emotionally, if you take too much then you become more sensitive. It intensifies your emotions. I don’t have a lot happen to me with a good dosage. So focused in on things that surroundings aren’t a big deal. If someone’s telling a joke than I’m like whatever. I’m used to listening to everyone because my brain moves that fast. Are not as hungry, metabolism speeds up but you don’t have desire to eat. When you get hungry you’re REALLY hungry. Make sure you eat even when not hungry to not be empty. Definitely not a placebo.

Patient Interview Cont. • Do you feel labeled/ stereotyped? Not stereotyped. I didn’t even think that I had

ADHD because I have turrets. When I was growing up my turrets was really bad so people were more focused on the turrets. No one really worried about the ADHD part. People don’t think a lot of the ADHD. You don’t really think that a person has ADHD; you just think they’re hyper. There are different levels of ADHD. You can’t really identify someone with ADHD just by looking at them.

• How has it changed over time? My ADHD is the same, but what changes is how you deal with it. As you grow up you realize you need to manage it. I can feel when my meds start wearing off; when that happens I will take a little break. You have to be structured, when the breaks over you have set goals and control your breaks (that’s how you can deal with it without the medication). When I was in 4th grade, something my mom would say, “Do 5 math problems and I’ll make you a PB&J.” She would give me random things to do between the 5 problems like riding my bike, etc. That’s how I structure my breaks now, a half an hour break after doing some homework.

• Anything else you want to add? I enjoy having ADHD. To a certain extent it makes you more driven. If you can deal with it, it makes you more likable. Sometimes it’s annoying, sometimes I feel that my brain goes so fast that I wear myself out, like when I want to be quiet but I am just not.

Video

• http://www.youtube.com/watch?v=-xM1X7if3SU

References• http://www.adult-child-add-adhd.com/categories/general/history_adhd.php• http://www.education.com/reference/article/Ref_How_Does_ADHD_Affect/• http://www.daytrana.com/about-adhd/managing-adhd-children.aspx• http://www.concerta.net/adult/adhd-symptoms-adult-adhd-vs-adhd-in-children.ht

ml• http://www.adultadhd.net/childhood-vs-adult/• http://www.webmd.com/add-adhd/guide/adhd-symptoms• http://www.helpguide.org/mental/adhd_add_diagnosis.htm• http://www.myadhd.com/treatmentsforadhd.html• http://adhdstrategies.com/ADHD-article.asp?articleID=630• http://www.diffen.com/difference/ADD_vs_ADHD• http://www.cdc.gov/ncbddd/adhd/data.html• http://www.goodtherapy.org/blog/adhd-medication-therapy/• http://content.healthaffairs.org/content/28/5/1549.full