Attention Deficit Hyperactivity Disorder

Attention Deficit Hyperactivity Disorder (ADHD) Course and Guide

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Definitions:

ADHD is one of the most common childhood disorders that can continue into adulthood.
According to the Center for Disease Control, ADHD affects approximately 9% of children ages 3-17 years of age and 4% of adults
Symptoms include inattention, impulsivity and hyperactivity

Symptoms of Inattention:

Easily distracted, unable to complete tasks
Difficulty focusing
Easily bored
Disorganized, losing things
Not listening when spoken to, difficulty following instructions
Processing information slower than others
Daydreaming

Symptoms of Impulsivity:

Impatience
Blurting out inappropriate comments
Lack of emotional restraint
Acting without regard for consequences
Difficulty waiting for their turn

Symptoms of Hyperactivity:

Fidgeting/squirming, touching things
Excessive talking
Constantly moving
Difficulty doing quiet tasks

Causes Linked to ADHD:

Genetic:

Research suggests that ADHD runs in families
Researchers are evaluating a link to genes that may predispose people to ADHD
Additional research shows a possible connection to brain tissue abnormalities that can improve as children grow up, reducing symptoms

Environmental Factors:

Studies show a connection between cigarette smoking and drinking alcohol during pregnancy and ADHD in children.
Small children exposed to lead have a higher risk of developing ADHD.

Other Factors:

Children with a Traumatic Brain Injury (TBI) may exhibit behaviors similar to ADHD
Only a small percentage of children with ADHD have a TBI.
Some believe that sugar and food additives are related to ADHD, but there is lack of research to support these theories.

Diagnoses and treatment:

Diagnosing ADHD:

Normal behaviors can be mistaken for ADHD
- ADHD-like symptoms may occur in ages 3-6 years
- No single test can determine diagnoses
- Mental health specialist must diagnose

Pediatrician and mental health specialist may have to rule out other possibilities for behaviors/symptoms

Treatment:

Include medication, psychotherapy, education/training or a combination of these
There is no known “cure”
Treatments focus on reducing symptoms and improving functioning
Parent training – helping develop positive parent skills to assist child in a less frustrating manner
Parent-child interaction therapy – coaching parents to help improve communication to decrease problem behaviors
Individual and family therapy – to improve communication on both sides
Cognitive problem-solving training – helping the child identify and change thought patterns
Social skills training – helping the child to interact more positively with peers

Conditions that May Coexist with ADHD:

Learning disabilities
Oppositional defiant disorder (ODD)
Conduct disorder
Anxiety and depression
Bipolar Disorder
Tourette Syndrome
Mood disorders
Substance use disorders

Most Prevalent of these Conditions is Oppositional defiant disorder (ODD) characterized by:

Angry/Irritable Mood – loses temper often, touchy or easily annoyed, angry and resentful.
Argumentative/Defiant Behavior – challenges authority figures, actively defies authority or rules
Vindictiveness – has become vindictive or spiteful at least two times in the past six months.

Note: For this to be considered a disorder it must interfere in the ability to maintain relationships and/or interfere with the relationships/job/school.

ADHD in Teens:

ADHD symptoms may continue into adolescence or may not be diagnosed until adolescence.

Behaviors Associated with ADHD Teens:

Hyperactive/restless – may try to do too many things at once
Inability to delay reward – choosing activities that result in a quick payoff
Struggling in school
Difficulties in self-reliant activities
May have difficulty maintaining their ADHD treatment
Risk taking/rule breaking
Impulsive
Short-tempered

ADHD Teens and Driving:

Involved in nearly four times as many car crashes as teens who do not have ADHD
More likely to cause injury crashes
Get three times as many speeding tickets as their peers

ADHD in Adults:

ADHD may continue into or be diagnosed in adulthood.

Possible ADHD Symptoms in Adults:

Disorganized
Difficulty at work or unable to keep a job
Difficulty in relationships
Being responsible and productive may be challenging
May have multiple traffic accidents
Seeking out quick fixes rather than taking steps to achieve greater rewards

ADHD in the Criminal Justice System:

Individuals with ADHD may be more likely to commit crimes, be incarcerated and/or be victims of crime. They may be easily manipulated into committing crimes. ADHD is also associated with some career criminal-related disorders such as Conduct Disorder and Antisocial Personality Disorder. Evidence suggests that treatments for ADHD may help reduce likelihood of criminal activity and criminal recidivism.
Criminals with ADHD may be more likely to commit impulsive, emotionally reactive crimes such as:

Shoplifting
Battery
Assault
Traffic Violations
Vandalism

Considerations When Interacting with ADHD Citizens:

Ask one question at a time
Be clear, simple and direct
Repeat questions/instructions
Subject may have agitation/outbursts
Subject may have poor memory
Subject may have impaired sense of time/direction
Subject may seem hasty, trying to rush through conversation
Subjects may seem bored or distracted

Resources

National Institute of Mental Health
Attention Deficit Disorder Association
American Psychiatric Association
Centers for Diseases Control and Prevention
Psych Central
Mayo Clinic

References

Diagnostic and statistical manual of mental disorders: DSM-V-TR. (2013). American Psychiatric Association.

Faraone SV, Perlis RH, Doyle AE, Smoller JW, Goralnick JJ, Holmgren MA, Sklar P. Molecular genetics of attention-deficit/hyperactivity disorder. Biological Psychiatry, 2005; 57:1313-1323.

Khan SA, Faraone SV. The genetics of attention-deficit/hyperactivity disorder: A literature review of 2005. Current Psychiatry Reports, 2006 Oct; 8:393-397.

Shaw P, Gornick M, Lerch J, Addington A, Seal J, Greenstein D, Sharp W, Evans A, Giedd JN, Castellanos FX, Rapoport JL. Polymorphisms of the dopamine D4 receptor, clinical outcome and cortical structure in attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 2007 Aug; 64(8):921-931.

Linnet KM, Dalsgaard S, Obel C, Wisborg K, Henriksen TB, Rodriguez A, Kotimaa A, Moilanen I, Thomsen PH, Olsen J, Jarvelin MR. Maternal lifestyle factors in pregnancy risk of attention-deficit/hyperactivity disorder and associated behaviors: review of the current evidence. American Journal of Psychiatry, 2003 Jun; 160(6):1028-1040.

Mick E, Biederman J, Faraone SV, Sayer J, Kleinman S. Case-control study of attention-deficit hyperactivity disorder and maternal smoking, alcohol use, and drug use during pregnancy. Journal of the American Academy of Child and Adolescent Psychiatry, 2002 Apr; 41(4):378-385.

Braun J, Kahn RS, Froehlich T, Auinger P, Lanphear BP. Exposures to environmental toxicants and attention-deficit/hyperactivity disorder in U.S. children. Environmental Health Perspectives, 2006 Dec; 114(12):1904-1909.

Cox DJ, Merkel RL, Moore M, Thorndike F, Muller C, Kovatchev B. Relative benefits of stimulant therapy with OROS methylphenidate versus mixed amphetamine salts extended release in improving the driving performance of adolescent drivers with attention-deficit/hyperactivity disorder. Pediatrics, 2006 Sept; 118(3):e704-e710.

Oppositional defiant disorder (ODD). (2015, February 06). Retrieved January 17, 2018, from https://www.mayoclinic.org/diseases-conditions/oppositional-defiant-disorder/symptoms-causes/syc-20375831

Oppositional Defiant Disorder Symptoms. (2018, January 15). Retrieved January 17, 2018, from https://psychcentral.com/disorders/oppositional-defiant-disorder-symptoms/

Coccaro, E.F. (2012) Intermittent explosive disorder as a disorder of impulsive aggression for DSM-5. American Journal of Psychiatry. 169:577-588.

McLaughlin, K.A., Green, J. Hwang, I.,Sampson, N.A.,Zaslavsky, A.M & Kessler, R.C. (2012) Intermittent explosive disorder in the National Comorbidity Survey Replication Adolescent Supplement. Archives of General Psychiatry. 69(11): 1131-9

Morland. L.A., Love, A.R, Mackintosh, M.A., Greene, C.J. & Rosen, C.S. (2012). Treating Anger and Aggression in Military Populations: Research Updates and Clinical Implications. Clinical Psychology: Science and Practice, 19 (3): 305-322

Nickerson, A., Aderla, I.M., Hofmann, S.G., & Bryant, R.A. (2012) The relationship between childhood exposure to trauma and intermittent explosive disorder. Psychiatry Research, 197 1-2: 128-134

Schmidt, F., Korber, Stephanie, Zwann, M. & Muller, A. (2012). Impulse control disorders in obese patients. European Eating Disorder Review, 20(3): 144-147

Young, Joel L., MD. "ADHD and Crime: Considering the Connections." Medscape.org. Medscape Education Psychiatry & Mental Health, 12 Apr. 2010. Web. 25 Feb. 2016.

Science Writing, Press & Dissemination Branch. Attention Deficit Hyperactivity Disorder. N.p.: Science Writing, & Dissemination Branch, 2008. National Institute of Mental Health. NIMH Publications No. 08-3572, 2008. Web. 25 Feb. 2016. <http://www.nimh.nih.gov>.

ADHD