section 2 - adhd & hyperkinetic disorder

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Lecturer: Simon Bignell

Section: 2 of 11

‘Autism, Asperger’s & ADHD’ (6PS055)

‘ADHD, Autism & Asperger’s’ (6PS077)

ADHD and Hyperkine

tic Disorder

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Section: 2 of 11



Introduction to the Section• Symptoms of ADHD

– Inattention– Hyperactivity/Impulsiveness

• Prevalence• Comorbidity• Developmental course of ADHD• Consequences of ADHD• Lifespan• Controversy

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Section: 2 of 11



Learning Outcomes of this SectionOn completion of the Section and with

independent study you should be able to: 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.

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Section: 2 of 11



What is ADHD?

• Problems with Attention, 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.”

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Section: 2 of 11



What is ADHD?

• First described around 100 years ago

• Also known as ADD, Hyperactivity, Hyperkinetic Disorder in UK (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

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What is ADHD?

• DSM-IV-TR - Three main subtypes: – Predominantly Inattentive

Type

– Predominantly Hyperactive-Impulsive Type

– Combined Type

– ADHD not otherwise specified

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Section: 2 of 11



• Hyperactivity/Impulsivity– poor self-monitored behaviour.– 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.

Symptoms of ADHD

ADHD

ImpulsivenessImpulsiveness

InattentionInattention

Combined Combined typetype

Hyperactive- Hyperactive- Impulsive typeImpulsive type

InattentiveInattentive

typetype

HyperactivityHyperactivity

61%30% 9%

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Inattention

• Failure to pay close attention to details or making careless 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…

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Inattention

• Excessive distractibility • 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

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Hyperactivity-impulsive behaviour

• Fidgeting with hands or feet or squirming in seat • 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

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• ADHD is a common developmental disorder affecting 2-5% of school age children in UK

• 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

Prevalence of ADHD

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ComorbidityADHD

Poor Language Skills(pragmatic skills/ comprehension

/ verbal fluency)

Executive Function Impairment(planning / organising/

digit span/ following instruction etc.)

Motor Coordination

Behavioural & emotional Problems

(ODD, CD,OCD, Depression)

Inhibition Deficits(Behavioural & verbal self regulation)

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Comorbidity

• Substance Use Disorders in Adults With ADHD– Alcohol abuse (15%)– Alcohol dependence (41%)– Substance abuse (45%)– Substance dependence (31%)– Any abuse or dependence (69%)

(Millstein, et al, 1997)

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Comorbidity

• Mood and Anxiety Disorders in Adults With ADHD– Major Depression (63%)– Dysthymia (23%)– Bipolar (17%)– Panic Disorder (11%)– Simple Phobia (12%)– Generalized Anxiety (21%)– Obsessive Compulsive Disorder (7%)


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• Personality Disorders in Adults With ADHD– Anti-social personality (22%)– Passive aggressive personality (19%)– Borderline personality (14%)– Histrionic personality disorder (11%)– Avoidant (Anxious) (11%)

(Barkley et al, 1998)

Comorbidity

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Causes of ADHD

• The causes of ADHD are not fully known– Likely to have multiple causes and complex

interactions– 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

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DSM

• 1980 – The name Attention Deficit Disorder (ADD) 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.

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• Clear DSM criteria but reality is different – clinician’s judgement

• The cut-off between normal-but difficult temperament and ADHD is not clearly definable

• No single reliable test for ADHD

Diagnostic Criteria for ADHD

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• Preschool and Kindergarten Years– 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

Developmental Course of ADHD

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• Infancy and Toddler Years– Irritability– Shrill, frequent crying– Overactive and restless– Sleep problems– Fussy eater– Difficulty adapting well to changes in the

environment– Difficulty nursing and feeding


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• Primary School Years– Typically diagnosed in primary

school years– Falls behind in academic

performance– Trouble following rules– Cannot sit quietly– Finds it hard paying attention– Difficulty working cooperatively

or productively


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• Secondary School Years– Academic difficulties (esp. literacy)– Challenge parents authority– Poor self-management– Poor time-awareness / lateness– Forgetfulness– Easily bored– Impulsive and irritable– Immaturity– High-risk behaviours


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Section: 2 of 11




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


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• Inattention and Hyperactivity impact on development generally

• Some research characterises ADHD as a ‘developmental lag’

• The symptoms of ADHD lead to a vast number of negative consequences and high comorbidity

Consequences of ADHD

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Consequences of ADHDFollow-up studies of clinical samples suggest that

sufferers are far more likely than normal people to:

• 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.

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Consequences of ADHDMoreover, children growing up with ADHD are

more likely to experience:

• 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.

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• ADHD is a disorder that persists across the lifespan

• 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

Lifespan of ADHD

Industry of ADHD

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Controversy surrounding ADHD

“No mental disability this decade has been assailed by as 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)

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Weekly Group Seminars (For on-campus students)

• Group meetings for discussion, debate, workshop activities, videos and looking at research papers/publications. You’ll be expected to do academic reading for these.

• Seminar group allocations on the Forum.

Group Seminars (For distance-learning students)

• Online activities and Forum discussions of academic papers. You’ll be expected to do academic reading for these.

section 2 - adhd & hyperkinetic disorder

Education