history of ADHD
ADHD has been around since the agricultural society
Name has been changed over time
-Minimal Brain Dysfunction (damage): 1900-1950
-Hyperkinetic / Hyperactivity Syndrome (DSM-II of 1968): 1950-1969
-Recognition of Attentional impairment and Impulsivity: 1970-1979
-DSM-III and “ADD” with or without Hyperactivity: 1980
-ADD becomes ADHD (DSM-III R) with mixed criteria: 1987
-NOW: ADHD (inattentive, hyperactive, combined subtypes) in DSM-IV: 1994
classic triad of ADHD
Inattention
Hyperactivity
Impulsivity
hyperactive symptoms
- Fidgets
- Leaves seat
- Runs or climbs excessively (or restlessness)
- Difficulty engaging in leisure activities quietly
- “On the go” or “driven by a motor”
- Talks excessively
- Blurts out answers before question is completed
- Difficulty waiting turn
- Interrupts or intrudes on others
inattentive symptoms
- Makes careless mistakes/poor attention to detail
- Difficulty sustaining attention in tasks/play
- Does not seem to listen when spoken to directly
- Difficulty organizing tasks/activities
- Avoids tasks requiring sustained mental effort
- Loses items necessary for tasks/activities
- Easily distracted by extraneous stimuli
- Often forgetful in daily activities
functional criteria
- 6 of 9 symptoms in either or both categories
- Inattentive; hyperactive-impulsive; or combined type
- Persisting for at least 6 months
- Some symptoms present before 12 years old
- Impairment in 2 or more settings
- Social / academic / occupational impairment
natural history
Age related changes:
Preschool (3-5 y/o) - hyperactive/impulsive
School age (6-12 y/o) - combination symptoms
Adolescence (13-18 y/o) - more inattention with restlessness
Adult (18+) - largely inattentiveness with periodic impulsivity
rule of thirds
⅓ → complete resolution
⅓ → continued inattention, some impulsivity
⅓ → early ODD/CD, poor academic achievement, substance abuse, antisocial adults
findings from the MTA study
medication is looked as the treatment of choice
Four treatment arms:
- Medication (MED)
- Behavior therapy (BEH)
- Combined (COMB)
- Community “control” (CC)
establishing a diagnosis
there are no tests
- must look for characteristics of behavior
- collateral interviews
- symptoms in more than one setting
-
symptoms and subtypes of ADHD
Inattentive; hyperactive-impulsive; or combined type
prevalence
Most commonly diagnosed behavioral disorder of childhood (1 in 20 worldwide)
3-7% of school children are affected in US !!!!!
age importance
Kids first get diagnosed when they enter school
Can diagnose before
gender importance
Males:females = 2-9:1
Boys
- tend to get diagnosis earlier and more often
- Hyperactive and impulsive subtype
Girls
- Behavior is judged
- Social expectations
race importance
Latino and black children are less likely to be diagnosed with ADHD by parent report than are white children
Black children with ADHD are less likely to receive stimulants than white children
impairments in executive functioning
Means –> how we organize and plan, how we hold things in memory
- Working memory
- Difficulties with planning
- Goal directed behaviors, including strategic planning, impulse control, organized search, and flexibility of thought and action
brain areas implemented in ADHD
Prefrontal cortex
- Develops more slowly
ADHD groups have smaller posterior brain regions (occipital lobes)
