Tag Archives: Attention Deficit

Attention Deficit/Hyperactivity Disorder (ADHD)

  1. Symptoms: Hyperactivity (squirming, fidgeting, and restless behavior); attention deficit (distractibility, frequent shifts from one uncomplete activity to another, careless mistakes, poor organization or effort, and general “spaciness”); struggle with learning far more than behavior control; several symptoms begin before the age of 12; want to “be good”, but are impulsive and have trouble behaving
  2. Diagnosis:
    1. A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (i) and (ii):
      1. Inattention: 6 (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities (Note: the symptoms are not solely a manifestation of the oppositional behavior, defiance, hostility, or failure to understand tasks or instructions. For older adolescents and adults age 17 and older, at least 5 symptoms are required):
        1. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (overlooks or misses details, work is inaccurate)
        2. Often has difficulty sustaining attention in tasks or play activities (has difficulty remaining focused during lectures conversations or lengthy reading)
        3. Often does not seem to listen when spoken to directly (mind seems elsewhere, even in the absence of any obvious distractions)
        4. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (starts tasks but quickly loses focus and is easily sidetracked)
        5. Often has difficulty organizing tasks and activities (difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganized work; has poor time management; fails to meet deadlines)
        6. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers)
        7. Often loses things necessary for tasks or activities (school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile phone)
        8. Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts)
        9. Is often forgetful in daily activities (daily chores, running errands; for older adolescents and adults, returning calls, paying bills, keeping appointments)
      2. Hyperactivity and impulsivity: 6 (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities (Note: the symptoms are not solely a manifestation of the oppositional behavior, defiance, hostility, or failure to understand tasks or instructions. For older adolescents and adults age 17 and older, at least 5 symptoms are required):
        1. Often fidgets wit or taps hands or feet or squirms in seat
        2. Often leaves seat in situations when remaining seated is expected (leaves his or her place in the classroom, in the office or other workplace, or in other situations that require remaining in place)
        3. Often runs about or climbs in situations where it is inappropriate (note: in older adolescents and adults, may be limited to feeling restless)
        4. Often unable to play or engage in leisure activities quietly
        5. Is often “on  the go” acting as if “driven by a motor” (is unable to be or is uncomfortable being still for an extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with)
        6. Often talks excessively
        7. Often blurts out an answer before the question has been completed (completes people’s sentences; cannot wait for turn in conversation)
        8. Often has difficulty waiting his or her turn (while waiting in line)
        9. Often interrupts or intrude on others (butts into conversations games, or activities; may start using other people’s things without asking or receiving permissions; for adolescents and adults, may intrude into or take over what others are doing)
    2. Several inattentive or hyperactive-impulsive symptoms were persistent prior to the age of 12
    3. Several inattentive or hyperactive-impulsive symptoms are present in 2 or more settings (home, school, work; with friends or relatives; in other activities)
    4. There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning
    5. The symptoms do not occur exclusively during the course of schizophrenia, or other psychotic disorder and are not better explained by another mental disorder (mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdraw)
  3. Course and Outcome: hyperactivity typically declines during adolescents, but attention deficits and impulsivity are more likely to continue ; prognosis for ADHD depends on whether or not there is a comorbid condition with oppositional defiant disorder or conduct disorder
  4. Frequency of Disorder: 9.5 % of children in the US have a lifetime diagnosis; 1 to 2% of children in Europe receive the diagnosis; diagnosis in the US increased by 2/3 between 2000 and 2010; more common among children of more affluent parents; 2 to 10 times as many boys as girls have externalizing problems
  5. Etiology:
    1. Family risk factors: increase fourfold when 2 are present and further when 3 or 4 are present: low income, overcrowding in the home, maternal depression, paternal antisocial behavior, conflict between parents, removal of child from the home
    2. Biological factors:
      1. Difficult temperament (inborn behavioral characteristics, including activity level, emotionality, and sociability)
      2. Neuropsychological abnormalities: brain damage was present on a CT scan in 5% of ADHD cases; many do not show soft signs (delays in fine motor coordination); minor anomalies in physical appearance, delays in reaching developmental milestones, maternal smoking and alcohol consumption, pregnancy and birth complications
      3. Genetics: couple be a single gene or could be polygenetic
      4. Social factors: socialization (process of shaping children’s behavior and attitudes to conform to the expectations of parents, teachers, and society)
      5. Parenting styles
      6. Coercion
      7. Negative attention: what seems to be a “punishment” sometimes may reinforce misbehavior
      8. Inconsistency in rules and expectations especially from parent to parent
      9. Influence of peers, neighborhoods, and media
      10. Psychological factors: low self-esteem, overestimation of self, self-protection, lack of self-control, delay of gratification
  6. Treatment:
    1. Psychostimulants (Ritalin, Dexedrine, Cylert, Adderall) increases alertness, arousal, and attention; shows improvements in behavior in about 75% of children with ADHD; taken for years, not days or weeks
    2. Antidepressants affect symptoms for unknown reasons
    3. Strattera for adults with ADHD and is the only nonstimulant medication approved by the US Food and Drug Administration
    4. Clonidine decreases aggressive behavior
    5. Behavioral Family Therapy (BFT) teaches parents to be very clear and specific about their expectations for children’s behavior to monitor children closely, and systematically reward positive behavior while ignoring or mildly punishing misbehavior; parent training; star charts or daily report cards; teaches punishment strategies such as time outs; rewards need to out weight punishments; goals is to teach authoritative parenting; benefits are generally limited to children under the age of 12; less effective when parents are unhappily marries, depressed, substance abusers, or harsh and critical with their children
    6. Problem-solving skills training (PSST) is one technique which children are taught to slow down, evaluate a problem, and consider alternative solution before acting
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