all that wiggles is not adhd history, assessment, and diagnosis of adhd
DESCRIPTION
All That Wiggles Is Not ADHD History, Assessment, and Diagnosis of ADHD. Jodi A. Polaha, Ph.D. Assistant Professor, Pediatrics Munroe-Meyer Institute, UNMC Director, Hastings Behavioral Health Clinic. Attention-Deficit Hyperactivity Disorder. History: Where did ADHD come from?. - PowerPoint PPT PresentationTRANSCRIPT
All That Wiggles Is Not ADHDHistory, Assessment, and Diagnosis of ADHD
Jodi A. Polaha, Ph.D.Assistant Professor, Pediatrics
Munroe-Meyer Institute, UNMCDirector, Hastings Behavioral Health Clinic
Attention-Deficit Hyperactivity Disorder
History: Where did ADHD come from?
“Defects in Moral Control”George Still, M.D. (1902)
A “cluster” of behaviors which:were more common in males seemed to run in familieswere associated with certain congenital anomalieswere not accounted for by any known neurological
deficit
Other Names/Classifications
Post-encephalic Brain Disorder Brain Injured Child Syndrome Minimal Brain Dysfunction Hyperkinetic Reaction of Childhood (DSM-II) Attention-Deficit Disorder (DSM-III, 1980)
Current Conceptualization
Attention-Deficit Hyperactivity Disorder (ADHD)
DSM-IV, 1994
Three subtypes:Predominantly InattentivePredominantly Hyperactive/ImpulsiveCombined
Adolescent and Adult Outcomes
Some symptoms into adolescence: 70% Some symptoms into adulthood: 50% At increased risk for:
Substance abuse Traffic citations Automobile accidents
Cause of ADHD
No one cause identified.
Not caused byDiet (i.e. food additives, sugar)Poor parenting
Other Myths/Misconceptions
ADHD is outgrown in adolescence.
Other Myths/Misconceptions
ADHD is outgrown in adolescence. Girls are not hyperactive.
Other Myths/Misconceptions
ADHD is outgrown in adolescence. Girls are not hyperactive. There is a single test for ADHD.
Other Myths/Misconceptions
ADHD is outgrown in adolescence. Girls are not hyperactive. There is a single test for ADHD. Stimulant medication can “diagnose”
ADHD.
Other Myths/Misconceptions
ADHD is outgrown in adolescence. Girls are not hyperactive. There is a single test for ADHD. Stimulant medication can “diagnose” ADHD. There is a “cure” for ADHD.
Prevalence of ADHD
Best current estimate:
3%-5% school age population are affected.
Attention-Deficit Hyperactivity Disorder
Diagnosis:
Who has ADHD?
Formal Diagnostic CriteriaDSM-IV, 1994
Criterion A:
Six or more symptoms from one or both of these lists:
Inattentive Type Hyperactive/Impulsive Type
…have been present for at least 6 months.
Symptom Lists
Inattentive Type fails to attend to details, makes
careless mistakes difficulty sustaining attention in
play or work does not listen when spoken to does not follow through difficulty organizing tasks avoids task requiring sustained
mental effort loses things needed distracted by extraneous stimuli often forgetful
Hyper/Impulsive Type often fidgets hands/feet or squirms often leaves seat when sitting is expected runs about or climbs excessively difficulty playing or engaging in leisure
activities quietly often “on the go”/ “driven by motor” talks excessively blurts out answers before questions
completed difficulty awaiting turn interrupts or intrudes on others
Formal Diagnostic CriteriaDSM-IV, 1994
Criterion B:
Some of the symptoms were present before the age of seven years.
Formal Diagnostic CriteriaDSM-IV, 1994
Criterion C:
Some impairment from the symptoms is present in two or more settings (e.g., home, and school or work).
Formal Diagnostic CriteriaDSM-IV, 1994
Criterion D:
There is evidence of clinically significant impairment in social, academic, or occupational functioning.
Formal Diagnostic CriteriaDSM-IV, 1994
Criterion E:
The identified symptoms are not better accounted for by another mental disorder.
Attention-Deficit Hyperactivity Disorder
Assessment:
All that wiggles is not ADHD
Comprehensive Diagnosis for ADHD
There is no single test or laboratory measure which can reliably detect ADHD.
Comprehensive Diagnosis for ADHD
Information gained by qualified clinician:From family
standardized, norm-referenced ratings detailed history
Comprehensive Diagnosis for ADHD
Information gained by qualified clinician:From family
standardized, norm-referenced ratings detailed history
From school standardized, norm-refernced ratings academic history in-class observations
Comprehensive Diagnosis for ADHD
Information gained by qualified clinician:From family
standardized, norm-referenced ratings detailed history
From school standardized, norm-referenced ratings academic history in-class observations
From clinician observations
Other Common Causes of Concentration Problems
Depression/anxiety
Other Common Causes of Concentration Problems
Depression/anxiety Drug/alcohol use
Other Common Causes of Concentration Problems
Depression/anxiety Drug/alcohol use Poor fit between academic demands and
individual’s capabilities
Other Common Causes of Concentration Problems
Depression/anxiety Drug/alcohol use Poor fit between academic demands and
individual’s capabilities Physical illness
Other Common Causes of Concentration Problems
Depression/anxiety Drug/alcohol use Poor fit between academic demands and
individual’s capabilities Physical illness Adjustment
Associated Problems
Learning Disability: 25 - 30%
Associated Problems
Learning Disability: 25 - 30% Oppositional Defiant Disorder: 35 - 65%
Oppositional Defiant Disorder
Pattern of negative, hostile, and defiant behavior: Often loses temper Often argues with adults Often actively defies or refuses to comply with adults’ requests or
rules Often deliberately annoys people Often blames others for his/her mistakes or behavior Often touchy or easily annoyed by others Often angry or resentful Often spiteful or vindictive
Associated Problems
Learning Disability: 25 - 30% Oppositional Defiant Disorder: 35 - 65% Variable academic quality
Associated Problems
Learning Disability: 25 - 30% Oppositional Defiant Disorder: 35 - 65% Variable academic quality Poor social skills, peer relationships
Who Has ADHD?
0102030405060708090
100
ExtremelyAttentive
Average ExtremelyInattentive
Percent
Attentiveness
3-5%
Who Has ADHD?
0102030405060708090
100
ExtremelyAttentive
Average ExtremelyInattentive
Percent
Attentiveness
3-5%
3-15%?
ADHD as Heterogeneous Disorder
Inattentive Typefails to attend to details, careless mistakesdifficulty sustaining attention in play or workdoes not listen when spoken todoes not follow throughdifficulty organizing tasksavoids task requiring sustained mental effortloses things neededdistracted by extraneous stimulioften forgetful
Hyper/Impulsive Typeoften fidgets hands/feet or squirmsoften leaves seat when sitting is expectedruns about or climbs excessivelydifficulty playing or engaging in leisureoften “on the go”/ “driven by motor”talks excessivelyblurts out answers before questions completeddifficulty awaiting turninterrupts or intrudes on others
Associated ProblemsLearning DisabilityOppositional Defiant DisorderVariable academic qualityPoor social skills, peer relationships
ADHD as Heterogeneous Disorder
Inattentive Typefails to attend to details, careless mistakesdifficulty sustaining attention in play or workdoes not listen when spoken todoes not follow throughdifficulty organizing tasksavoids task requiring sustained mental effortloses things neededdistracted by extraneous stimulioften forgetful
Hyper/Impulsive Typeoften fidgets hands/feet or squirmsoften leaves seat when sitting is expectedruns about or climbs excessivelydifficulty playing or engaging in leisureoften “on the go”/ “driven by motor”talks excessivelyblurts out answers before questions completeddifficulty awaiting turninterrupts or intrudes on others
Associated ProblemsLearning DisabilityOppositional Defiant DisorderVariable academic qualityPoor social skills, peer relationships
ADHD as Heterogeneous Disorder
Inattentive Typefails to attend to details, careless mistakesdifficulty sustaining attention in play or workdoes not listen when spoken todoes not follow throughdifficulty organizing tasksavoids task requiring sustained mental effortloses things neededdistracted by extraneous stimulioften forgetful
Hyper/Impulsive Typeoften fidgets hands/feet or squirmsoften leaves seat when sitting is expectedruns about or climbs excessivelydifficulty playing or engaging in leisureoften “on the go”/ “driven by motor”talks excessivelyblurts out answers before questions completeddifficulty awaiting turninterrupts or intrudes on others
Associated ProblemsLearning DisabilityOppositional Defiant DisorderVariable academic qualityPoor social skills, peer relationships
Child with ADHDChild with ADHD
Importance of Diagnosis
Can help schools document need for additional services.
Research purposes. Professional communication.
But it doesn’t help individualize a treatment strategy!
Importance of Diagnosis
More important than a diagnosis:
is a comprehensive, functional assessment of the child’s impairment in daily life• with peers.• with teachers.• with siblings.• with parents.
New Conceptualization of ADHD
Dr. Russell Barkley:
“ADHD is a delay in the development of behavioral inhibition.”