Topic 2 - ADHD and Hyperkinetic Disorder 2010

1

UN

DE

RG

RA

DU

AT

E

1

33

Autism, Asperger’s & ADHD (6PS048)

ADHD, Autism & Asperger’s (6PS052)

Simon Bignell

Psychology, School of Science

ADHD and Hyperkinetic Disorder

Simon Bignell – Module Leader

Lecture 2

Spring 2010 (6PS048 & 6PS052)

2

UN

DE

RG

RA

DU

AT

E

2

33



Simon Bignell


Introduction to the Lecture• Symptoms of ADHD

– Inattention– Hyperactivity/Impulsiveness

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

3

UN

DE

RG

RA

DU

AT

E

3

33



Simon Bignell


Learning outcomes of this lecture

On completion of the lecture 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.

4

UN

DE

RG

RA

DU

AT

E

4

33



Simon Bignell


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.”

5

UN

DE

RG

RA

DU

AT

E

5

33



Simon Bignell


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

6

UN

DE

RG

RA

DU

AT

E

6

33



Simon Bignell


What is ADHD?

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

– Predominantly Hyperactive-Impulsive Type

– Combined Type

– ADHD not otherwise specified

7

UN

DE

RG

RA

DU

AT

E

7

33



Simon Bignell


• Hyperactivity/Impulsivity– poor self-monitored behaviour.– always ‘on the go’, fidget, restless. – cannot sit still, doesn’t wait for others.– Impatient, always taking, 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%

9

UN

DE

RG

RA

DU

AT

E

9

33



Simon Bignell


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…

10

UN

DE

RG

RA

DU

AT

E

10

33



Simon Bignell


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

11

UN

DE

RG

RA

DU

AT

E

11

33



Simon Bignell


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

12

UN

DE

RG

RA

DU

AT

E

12

33



Simon Bignell


ADHD (Video)

Video - 9 year old child with ADHD

Video viewable from the module website.

13

UN

DE

RG

RA

DU

AT

E

13

33



Simon Bignell


• 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

14

UN

DE

RG

RA

DU

AT

E

14

33



Simon Bignell


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)

15

UN

DE

RG

RA

DU

AT

E

15

33



Simon Bignell


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)

16

UN

DE

RG

RA

DU

AT

E

16

33



Simon Bignell


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%)


17

UN

DE

RG

RA

DU

AT

E

17

33



Simon Bignell


• 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

18

UN

DE

RG

RA

DU

AT

E

18

33



Simon Bignell


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

19

UN

DE

RG

RA

DU

AT

E

19

33



Simon Bignell


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.

20

UN

DE

RG

RA

DU

AT

E

20

33



Simon Bignell


• 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

21

UN

DE

RG

RA

DU

AT

E

21

33



Simon Bignell


• 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

22

UN

DE

RG

RA

DU

AT

E

22

33



Simon Bignell


• 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


23

UN

DE

RG

RA

DU

AT

E

23

33



Simon Bignell


• 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


24

UN

DE

RG

RA

DU

AT

E

24

33



Simon Bignell


• 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


25

UN

DE

RG

RA

DU

AT

E

25

33



Simon Bignell



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


26

UN

DE

RG

RA

DU

AT

E

26

33



Simon Bignell


• 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

27

UN

DE

RG

RA

DU

AT

E

27

33



Simon Bignell


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.

28

UN

DE

RG

RA

DU

AT

E

28

33



Simon Bignell


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.

29

UN

DE

RG

RA

DU

AT

E

29

33



Simon Bignell


• 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

31

UN

DE

RG

RA

DU

AT

E

31

33



Simon Bignell


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)

32

UN

DE

RG

RA

DU

AT

E

32

33



Simon Bignell


Any Questions?

33

UN

DE

RG

RA

DU

AT

E

33

33



Simon Bignell


Group Seminars (For campus-based 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.

Topic 2 - ADHD and Hyperkinetic Disorder 2010

Education

Transcript of Topic 2 - ADHD and Hyperkinetic Disorder 2010