ADHD: ADHD: Childhood and BeyondChildhood and Beyond

David M. Freed, Ph.D.David M. Freed, Ph.D.1180 Cross Street SE1180 Cross Street SE

Salem, OR 97302Salem, OR 97302Phone: 503-362-9357Phone: 503-362-9357

A Brief History of ADHDA Brief History of ADHD

Fidgety Phil was mentioned in 1865Fidgety Phil was mentioned in 1865 George Still (1902) described children who George Still (1902) described children who

were aggressive, defiant, and passionatewere aggressive, defiant, and passionate 1917-1918 influenza epidemic survivors1917-1918 influenza epidemic survivors The concept of Minimal Brain DysfunctionThe concept of Minimal Brain Dysfunction The rise of medication therapyThe rise of medication therapy Subtypes of ADHDSubtypes of ADHD Lingering symptoms of ADHD in adultsLingering symptoms of ADHD in adults

Diagnostic criteria for Diagnostic criteria for ADHD: InattentionADHD: InattentionSix or more of the following Six or more of the following symptoms of inattention have symptoms of inattention have persisted and caused significant persisted and caused significant problemsproblems

careless mistakescareless mistakesdifficulty sustaining attentiondifficulty sustaining attentionoften does not seem to listenoften does not seem to listenfails to finish assignmentsfails to finish assignmentsavoids effortful tasksavoids effortful taskseasily distractedeasily distractedoften forgetfuloften forgetful

Diagnostic criteria for ADHD:Diagnostic criteria for ADHD:Hyperactivity and ImpulsivityHyperactivity and Impulsivity

Six or more of the following symptoms of Six or more of the following symptoms of hyperactivity and impulsivity have persisted hyperactivity and impulsivity have persisted and caused problemsand caused problems

Often fidgetsOften fidgetsCan’t sit stillCan’t sit stillFeels restlessFeels restlessTalks excessivelyTalks excessivelyNoisyNoisyHas difficulty waiting turnHas difficulty waiting turnOften interrupts or intrudesOften interrupts or intrudes

ADHD is frequently associated ADHD is frequently associated with other disorders including:with other disorders including:

Conduct disordersConduct disorders Learning disabilitiesLearning disabilities Problems with emotional regulationProblems with emotional regulation Substance abuseSubstance abuse Relationship issuesRelationship issues Vocational difficultiesVocational difficulties

Other Problems Associated Other Problems Associated with ADHDwith ADHD

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

Other Problems Associated Other Problems Associated with ADHDwith ADHD

Problems with frustration toleranceProblems with frustration tolerance Academic and behavior problemsAcademic and behavior problems Variable performance across timeVariable performance across time More frequent accidents and injuriesMore frequent accidents and injuries Sleep difficultiesSleep difficulties

ADHD and Co-Occurring ADHD and Co-Occurring Psychiatric DisordersPsychiatric Disorders

(Adapted from Barkley, 1998)(Adapted from Barkley, 1998)

Anxiety Disorders (average 25%)Anxiety Disorders (average 25%) Major Depression (average 25%)Major Depression (average 25%) Bipolar Disorder (most likely 6-10%)Bipolar Disorder (most likely 6-10%) Somatization Disorder (24-35% of Somatization Disorder (24-35% of

adolescents)adolescents) Oppositional Defiant Disorder (average 35%)Oppositional Defiant Disorder (average 35%) Conduct Disorder (20-56%)Conduct Disorder (20-56%)

ADHD and Social ADHD and Social FunctioningFunctioning

(adapted from Barkley, 1998)(adapted from Barkley, 1998)

Poor peer relationshipsPoor peer relationships Low social acceptance/statusLow social acceptance/status Increased aggression against peersIncreased aggression against peers Less compliance to requestsLess compliance to requests More frequent requests for assistanceMore frequent requests for assistance More frequent reprimands and More frequent reprimands and

consequencesconsequences Frequent changes: job, relationship, Frequent changes: job, relationship,

residenceresidence

ADHD and Emotional ADHD and Emotional ProblemsProblems

Low self-esteemLow self-esteem Depressed and anxiousDepressed and anxious Quick temperedQuick tempered Frequent meltdownsFrequent meltdowns Substance abuseSubstance abuse Chaotic personal Chaotic personal

routinesroutines

Features That Support a Features That Support a Diagnosis of ADHDDiagnosis of ADHD

Life-long problems with attentionLife-long problems with attention

A family history of similar problems A family history of similar problems (e.g., parents, siblings, children)(e.g., parents, siblings, children)

Clinical presentation including Clinical presentation including restlessness, fidgetiness, and verbal restlessness, fidgetiness, and verbal digressionsdigressions

Features That Support a Features That Support a Diagnosis of ADHDDiagnosis of ADHD

History of academic and behavioral History of academic and behavioral problemsproblems

Sleep disorderSleep disorder

Associated features of anxietyAssociated features of anxiety

Associated features of depression Associated features of depression

ADHD Symptoms are Context-ADHD Symptoms are Context-Dependent: Dependent:

Advantage or Disadvantage?Advantage or Disadvantage?

High activity level can be an advantageHigh activity level can be an advantage

Mixed handedness is common and often Mixed handedness is common and often associated with excellent dexterityassociated with excellent dexterity

““Easy sociability” is the flip side of verbal Easy sociability” is the flip side of verbal impulsivityimpulsivity

Bias to novelty results in unique solutionsBias to novelty results in unique solutions

ADHD Symptoms: Advantage or ADHD Symptoms: Advantage or Disadvantage?Disadvantage?

Friends appreciate the genuine Friends appreciate the genuine expression of emotions (the flip side expression of emotions (the flip side of “quick tempered”)of “quick tempered”)

ADHD masks symptoms of depressionADHD masks symptoms of depression

Hypervigilance to tasks of personal Hypervigilance to tasks of personal interestinterest