Neurodevelopmental Disorders ADHD used to be under category of Childhood Development disorders onset in childhood usually before the child starts grade school central features inattention overactivity and impulsivity associated w numerous impairments behavioral cognitive social and academic problems emphasis on attention vs hyperactivity changed DSM III Attention Deficit Disorder with or without hyperactivity attention deficits were the focus not hyperactivity DSM IV and DSM 5 Attention Deficit Hyperactivity Disorder equal importance at least 6 inattention and or at least 6 hyperactive impulsive symptoms inattention makes careless mistakes difficulty sustaining attention does not seem to listen when spoken to directly does not follow through on instructions fails to finish work difficulty organizing tasks bad time management skills avoids sustained effort tasks i e preparing reports reviewing lengthy documents loses things easily distracted thoughts jumping from one thing to another often forgetful in daily activities not returning phone calls forgetting to go shopping etc hyperactive impulsive often fidgets with hands or feet or squirms often runs about or climbs excessively manifests as restlessness in adults difficulty engaging in activities quietly often leaves seat often on the go driven talks excessively difficulty waiting turn blurts out answers even though they know they shouldn t be doing it frequently interrupts butting into what others are doing different for adults 5 criteria instead of 6 persist for 6 months some symptoms need to be present before age 12 used to be age 7 but was changed because retrospectively it s hard to remember what things were like before you were 7 impairment in at least 2 settings i e school and home DSM 5 eliminates ADHD subtypes but you can still specify presentation combined predominately inattentive predominately hyperactive impulsive subtypes were eliminated b c most people were combined and some people would switch back and forth between subtypes problems w ADHD criteria just below threshold problem what do you do when someone only has 4 5 symptoms why 6 or 5 for adults criteria for age of onset is questionable changed from 12 to 7 shows that this is not set in stone criteria of symptoms for 6 months may be too long for preschoolers may be too long to wait for a kid who s 4 years old and is really suffering prevalence teachers report higher prevalence than parents according to DSM 5 prevalence is 5 of children 2 5 of adults course of ADHD many children w ADHD do have problems as adults 65 80 of children w ADHD still meet criteria as teens and close to 60 still demonstrate symptoms as adults either in remission or full criteria so people could be seen to grow out of it but this may be because they are better able to manage their symptoms or they choose jobs that are better suited for them many still have symptoms but it doesn t cause impairment like it did when they were younger problems w longitudinal studies big changes from DSM III to DSM IV small changes from DSM IV to DSM V also there s been less research on ADHD in adults than in kids gender differences more common in boys than girls 2 to 1 in childhood 1 6 to 1 in adulthood however this may be because studies of ADHD have almost always focused on boys and may have ignored how girls experience the disorder internalizing rather than externalizing etc ADHD symptoms may just look different in girls probability of ADHD diagnosis greatest in the US compared to other countries in the US more whites than other races are diagnosed w it ADHD often overlaps w oppositional defiant disorder conduct disorder and bipolar disorder poor inhibitory control ability to stop responding to a task when signaled may be an endophenotype of ADHD genetic contributions ADHD runs in families nuclear family members likely to have it also twice as common among identical twins than among fraternal twins 2 dopamine genes implicated in ADHD DAT1 DA transporter gene DRD4 DA receptor gene Ritalin acts on DA however these genes alone do not implicate ADHD neurobiological contributions abnormal frontal lobe development and functioning overall brain volume slightly smaller in those w ADHD there s an underactive part of the brain related to DA and norepinephrine kids w ADHD have less activation in the front of the brain when performing cognitive tasks the role of toxins no strong evidence that pesticides or sugar or food additives or allergens are related to ADHD smoking cigarettes while pregnant may be linked to child developing ADHD potential relationship btwn nicotine and DA fetus development psychosocial contributions children w ADHD may be viewed negatively by others constant negative feedback from peers and adults peer rejection and resulting social isolation low self esteem harder to make friends later on which leads to more social isolation no support for theory that parenting style causes ADHD family stress can exacerbate symptoms of ADHD but it can exacerbate symptoms of basically every disorder biology much more important than environment and psychosocial contributions biological treatment of ADHD medications can help to reduce impulsivity and hyperactivity and improve attention stimulant medications Ritalin Concerta Dexedrine Adderall longer lasting quickly reduce symptoms for 75 of cases reduces aggression improves concentration side effects include difficulty sleeping irritability problems w weight and appetite b c of side effects many parents don t want to medicate children risk for drug abuse however new drugs like Strattera have less risk for abuse stimulants work by helping people focus their attention certain drugs are more effective in certain individuals than others Ritalin is especially effective on those w ADRA2A gene benefits are not lasting following discontinuation behavioral treatments reinforcement programs setting goals like increasing amount of time child remains seated or the number of math problems completed and rewarding the child for improvements and punishing them for misbehaving with loss of rewards parent training teaching families how to respond constructively to child s behaviors and structure the child s day to help prevent difficulties social skills training classroom structure shorter assignments more breaks etc behavioral part of CBT helpful for adults w ADHD combined bio psychosocial treatments are highly recommended superior to medication or behavioral treatments alone for