ADHD: Childhood and Beyond

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ADHD Childhood and Beyond

• David M. Freed, Ph.D.
• 1180 Cross Street SE
• Salem, OR 97302
• Phone [phone]

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A Brief History of ADHD

• Fidgety Phil was mentioned in 1865
• George Still (1902) described children who were
  aggressive, defiant, and passionate
• 1917-1918 influenza epidemic survivors
• The concept of Minimal Brain Dysfunction
• The rise of medication therapy
• Subtypes of ADHD
• Lingering symptoms of ADHD in adults

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Diagnostic criteria for ADHD Inattention

• Six or more of the following symptoms of
  inattention have persisted and caused significant
  problems
• careless mistakes
• difficulty sustaining attention
• often does not seem to listen
• fails to finish assignments
• avoids effortful tasks
• easily distracted
• often forgetful

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Diagnostic criteria for ADHDHyperactivity and
Impulsivity

• Six or more of the following symptoms of
  hyperactivity and impulsivity have persisted and
  caused problems
• Often fidgets
• Cant sit still
• Feels restless
• Talks excessively
• Noisy
• Has difficulty waiting turn
• Often interrupts or intrudes

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ADHD is frequently associated with other
disorders including

• Conduct disorders
• Learning disabilities
• Problems with emotional regulation
• Substance abuse
• Relationship issues
• Vocational difficulties

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Other Problems Associated with ADHD

• Reduced test performance (i.e., IQ)
• Impaired planning ability
• Excessive talking
• Poor organization
• Difficulty with problem solving
• Poor rule-governed behavior

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Other Problems Associated with ADHD

• Problems with frustration tolerance
• Academic and behavior problems
• Variable performance across time
• More frequent accidents and injuries
• Sleep difficulties

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ADHD and Co-Occurring Psychiatric
Disorders(Adapted from Barkley, 1998)

• Anxiety Disorders (average 25)
• Major Depression (average 25)
• Bipolar Disorder (most likely 6-10)
• Somatization Disorder (24-35 of adolescents)
• Oppositional Defiant Disorder (average 35)
• Conduct Disorder (20-56)

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ADHD and Social Functioning(adapted from
Barkley, 1998)

• Poor peer relationships
• Low social acceptance/status
• Increased aggression against peers
• Less compliance to requests
• More frequent requests for assistance
• More frequent reprimands and consequences
• Frequent changes job, relationship, residence

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ADHD and Emotional Problems

• Low self-esteem
• Depressed and anxious
• Quick tempered
• Frequent meltdowns
• Substance abuse
• Chaotic personal routines

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Features That Support a Diagnosis of ADHD

• Life-long problems with attention
• A family history of similar problems (e.g.,
  parents, siblings, children)
• Clinical presentation including restlessness,
  fidgetiness, and verbal digressions

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Features That Support a Diagnosis of ADHD

• History of academic and behavioral problems
• Sleep disorder
• Associated features of anxiety
• Associated features of depression

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ADHD Symptoms are Context-Dependent Advantage
or Disadvantage?

• High activity level can be an advantage
• Mixed handedness is common and often associated
  with excellent dexterity
• Easy sociability is the flip side of verbal
  impulsivity
• Bias to novelty results in unique solutions

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ADHD Symptoms Advantage or Disadvantage?

• Friends appreciate the genuine expression of
  emotions (the flip side of quick tempered)
• ADHD masks symptoms of depression
• Hypervigilance to tasks of personal interest