Attention Deficit Hyperactivity Disorder ADHD BY MICHAEL PELSTER AND SARAH LEGGETT Some Basics ADHD ADD Global prevalence is approximately 5 Boys vs Girls Considered to be a chronic disease 30 50 Diagnostic Criteria DSM IV Diagnostic criteria for Attention Deficit Hyperactivity Disorder cautionary statement A Either 1 or 2 1 inattention six or more of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level a often fails to give close attention to details or makes careless mistakes in schoolwork work or other activities b often has difficulty sustaining attention in tasks or play activities c often does not seem to listen when spoken to directly d often does not follow through on instructions and fails to finish school work chores or duties in the workplace not due to oppositional behavior or failure to understand instructions e often has difficulty organizing tasks and activities f often avoids dislikes or is reluctant to engage in tasks that require sustained mental effort such as schoolwork or homework g often loses things necessary for tasks or activities e g toys school assignments pencils books or tools h is often easily distracted by extraneous stimuli i is often forgetful in daily activities Diagnostic Criteria DSM IV continued 2 hyperactivity impulsivity six or more of the following symptoms of hyperactivity impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level Hyperactivity a often fidgets with hands or feet or squirms in seat b often leaves seat in classroom or in other situations in which remaining seated is expected c often runs about or climbs excessively in situations in which it is inappropriate in adolescents or adults may be limited to subjective feelings of restlessness d often has difficulty playing or engaging in leisure activities quietly e is often on the go or often acts as if driven by a motor f often talks excessively Impulsivity g often blurts out answers before questions have been completed h often has difficulty awaiting turn i often interrupts or intrudes on others e g butts into conversations or games B Some hyperactive impulsive or inattentive symptoms that caused impairment were present before age 7 years C Some impairment from the symptoms is present in two or more settings e g at school or work and at home D There must be clear evidence of clinically significant impairment in social academic or occupational functioning E The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder Schizophrenia or other Psychotic Disorder and are not better accounted for by another mental disorder e g Mood Disorder Anxiety Disorder Dissociative Disorders or a Personality Disorder Code based on type 314 01 Attention Deficit Hyperactivity Disorder Combined Type if both Criteria A1 and A2 are met for the past 6 months 314 00 Attention Deficit Hyperactivity Disorder Predominantly Inattentive Type if Criterion A1 is met but Criterion A2 is not met for the past 6 months 314 01 Attention Deficit Hyperactivity Disorder Predominantly Hyperactive Impulsive Type if Criterion A2 is met but Criterion A1 is not met for the past 6 months Causes Genetics Pre natal Environment Diet Environmental Social Factors Criticism Hunter vs Farmer Theory Neurodiversity Social Construct Why is it so controversial from McMaster U 1 No precise test 2 Frequently changing diagnostic standards 3 Not able to be cured flawed 4 Type of therapy stimulants 5 Diagnostic rates differ by country Pharmacological Treatment Stimulants Adderall and Ritalin methylphenidate Adderall inhibits mono amine transporters increasing levels of dopamine norepinephrine and serotonin and MAO s at high doses Ritalin methylphenidate norepinephrine and domanine reuptake inhibitor closest pharmaceutical analog to cocaine however cocaine has a higher infinity for the dopamine transporter contributing to euphoria the method of ingestion is almost important here Pharmacological Treatment Non stimulant Strattera atomoxetine Selective norepinephrine reuptake inhibitor Lower abuse potential but not as effective Potential Side Effects Common side effects of stimulants for ADD ADHD Feeling restless and jittery Difficulty sleeping Loss of appetite Headaches Upset stomach Irritability mood swings Depression Dizziness Racing heartbeat Tics Stimulant medications may also cause personality changes Some people become withdrawn listless rigid or less spontaneous and talkative Others develop obsessivecompulsive symptoms Potential Side Effects continued Stimulant safety concerns Beyond the potential side effects there are a number of safety concerns associated with the stimulant medications for ADD ADHD Effect on the developing brain The long term impact of ADD ADHD medication on the youthful developing brain is not yet known Some researchers are concerned that the use of drugs such as Ritalin in children and teens might interfere with normal brain development Heart related problems ADD ADHD stimulant medications have been found to cause sudden death in children and adults with heart conditions The American Heart Association recommends that all individuals including children have a cardiac evaluation prior to starting a stimulant An electrocardiogram is recommended if the person has a history of heart problems Psychiatric problems Stimulants for ADD ADHD can trigger or exacerbate symptoms of hostility aggression anxiety depression and paranoia People with a personal or family history of suicide depression or bipolar disorder are at a particularly high risk and should be carefully monitored when taking stimulants Potential for abuse Stimulant abuse is a growing problem particularly among teens and young adults College students take them for a boost when cramming for exams or pulling all nighters Others abuse stimulant meds for their weightloss properties If your child is taking stimulants make sure he or she isn t sharing the pills or selling them From today s NY Times A small study of children with attention deficit hyperactivity disorder last year found that walks outdoors appeared to improve scores on tests of attention and concentration Notably children who took walks in natural settings did better than those who walked in urban areas according to the report published online in August in The Journal of Attention Disorders The researchers found