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ADHD: Fact or Fiction?

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Chelsea Niemeyer

on 16 April 2013

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Transcript of ADHD: Fact or Fiction?

What will be covered: What is ADHD?
Process of Diagnosing
Theories of ADHD
Treatment options Chelsea Niemeyer
Joanie Emerson
Tyler Wakeley
Elizabeth Boynton References ADDitude Editors, A. (2008). Additude. Retrieved from
ADHD History. (2012). ADHD-Brain. Retrieved February 24, 2013, from
Christian, N. (2004). What is adhd (attention deficit
hyperactivity disorder)?. Retrieved from http://www.medicalnewstoday.com/info/adhd/
Elsevier (2012, July 30). Brain development delayed in ADHD,
study shows. ScienceDaily. Retrieved February 25, 2013, http://www.sciencedaily.com­/releases/2012/07/120730094822.htm
Gardner, A. (2010, November 18). Can food additives affect
adhd?. Retrieved from http://www.cnn.com/2010/HEALTH/11/18/health.food.additives.adhd/index.html
Gluck, S. (2012, October 23). Types of ADHD: Inattentive Type, Hyperactive Type,
Combined Type - HealthyPlace. HealthyPlace.com - Trusted Mental Health Information and Support - HealthyPlace. Retrieved February 24, 2013, from http://www.healthyplace.com/adhd/adhd-children/types-of-adhd-inattentive-type-hyperactive-type-combined-type/
Hallowell, E. M., & Ratey, J. J. (1994). Adhd - The Evolution Of A Disorder | PBS - Medicating Kids | FRONTLINE | PBS.
PBS: Public Broadcasting Service. Retrieved February 24, 2013, from http://www.pbs.org/wgbh/pages/frontline/shows/medicating/adhd/evolution.html
Iannelli, V. I. (2011, March 14). ADHD - History of ADHD. About Pediatrics - Pediatric Parenting and Medical Advice.
Retrieved February 24, 2013, from http://pediatrics.about.com/od/adhd/a/history_adhd.htm
Iliades, C. (2010, August 31). The Past, Present, and Future of ADHD - ADHD Center - Everyday Health. Health
Information, Resources, Tools & News Online - EverydayHealth.com. Retrieved February 24, 2013, from http://www.everydayhealth.com/adhd-awareness/an-adhd-timeline.aspx
Jockers, D. (2011, May 04). Beat adhd naturally. Retrieved from
Lawrence Robinson. , Melinda Smith, , & Jeanne Segal (2012,
November). Adhd help guide. Retrieved from
Michigan State University (2004). DSM-IV Definition. School Psychology Program. Retrieved February 24, 2013, from
Polanckzy, G.,Silva de Lima, M., Horta, B.L., Biederman, J., and
Rohde, L.A. The Worldwide Prevalence of ADHD: A systematic Review and Metaregression Analysis, The American Journal of Pychiatry; June 2007, 942-948
Regina, B. (2010, April 6). Psychcentral. Retrieved from
Vlam, S. (2006). Attention-deficit/hyperactivity disorder: diagnostic assessment methods used by advanced practice registered nurses.
Pediatric Nursing, 32(1), 18. Discussion Questions At what age do you think it's appropriate to diagnose/implement interventions (pharmacological/non-pharmacological?) Should pediatricians be allowed to diagnose children with mental health disorders? Characteristics
of ADHD Inattentiveness Hyperactivity Mixed Medications
for ADHD Stimulants Non Stimulants How do stimulants work? Common side effects How do they work? Common side effects ADHD: Fact or Fiction? Are we diagnosing/treating children for a disorder that does or does not exist? Most common type of medication prescribed for ADHD
These medications include:
Adderall (intermediate-acting)
Adderall XR (long-acting)
Concerta (long-acting)
Dexedrine (short-acting)
Dexedrine spansule (intermediate-acting)
Daytrana (a patch that delivers the drug on a long- or shorter-acting basis)
Metadate CD (long-acting)
Metadate ER (intermediate-acting)
Methylin ER (intermediate-acting)
Ritalin (short-acting)
Vyvanse For someone with ADHD, stimulants regulate impulsive behavior and improve attention span and focus by increasing the levels of certain chemicals in the brain, such as dopamine and norepinephrine, which help transmit signals between nerves.
They tend to reduce interruptive behavior, fidgeting, and other hyperactive symptoms, as well as help a person finish tasks and improve his or her relationships. Feeling restless and jittery
Difficulty sleeping
Loss of appetite
Upset stomach
Irritability, mood swings
Racing heartbeat
WITH STIMULANTS 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 weight-loss properties. If your child is taking stimulants, make sure he or she isn’t sharing the pills or selling them. Strattera, also known by its generic name atomoxetine, is the only non-stimulant medication approved by the FDA for ADD/ADHD treatment. Unlike stimulants, which affect dopamine, Strattera boosts the levels of norepinephrine, a different brain chemical.
Since it has some antidepressant properties, it’s also a top choice for those with co-existing anxiety or depression.
Abdominal pain or upset stomach
Nausea and vomiting
Mood swings Call the doctor immediately if your child shows agitation, irritability, suicidal thinking or behaviors, and unusual changes in behavior. SAFETY CONCERNS
WITH NON STIMULANTS Strattera may cause an increase in suicidal thoughts Have you ever had trouble concentrating? Find it hard to sit still sometimes? Do you daydream
often? Had difficulty focusing on the task at hand? An estimated 3 to 5 per cent of children are affected – approximately 2 million children in the US.

ADHD is among the most common mental disorders among children.

ADHD is about three times more common among boys than girls.

The symptoms of ADHD do not always go away – up to 60 per cent of child patients retain their symptoms into adulthood.

ADHD has been identified in every nation and culture that has been studied. Psychotherapy Behavior Therapy Parenting Skills Training Family Therapy Dietary Changes Exercise Non pharmacological treatment
options for ADHD Support Groups Social Skills Training This allows older children with ADHD to talk about issues that bother them, explore negative behavioral patterns and learn ways to deal with their symptoms. Teachers and parents can learn behavior-changing strategies for dealing with difficult situations. These strategies may include token reward systems and timeouts. This can help parents develop ways to understand and guide their child's behavior.These parent training exercises help the parent learn to help their child who has attention deficit disorder, keep their behavior on-task, and correct it in a positive and reinforcing manner when needed. Family therapy can help parents
and siblings deal with the stress
of living with someone who
has ADHD. This can help children learn appropriate
social behaviors.Skills include learning how to have conversations with others, learning to see others’ perspective, listening, asking questions, the importance of eye contact, what body language and gestures are telling you. Support groups can offer children with ADHD and their parents a network of social support, information and education. Although there is still little evidence supporting the relationship between food additives and ADHD, replacing sugary foods with fruits and vegetables is encouraged. When you walk, run, or do a set of jumping jacks or pushups, your brain releases several important chemicals.

Endorphins, for one, hormone-like compounds that regulate mood, pleasure, and pain. That same burst of activity also elevates the brain’s dopamine, norepinephrine, and serotonin levels. These brain chemicals affect focus and attention, which are in short supply in those with ADHD.

Studies have also found that tae kwon do, ballet, and gymnastics, in which you have to pay close attention to body movements, tax the attention system The person finds it very difficult to organize or finish a task. They find it hard to pay attention to details and find it difficult to follow instructions or conversations. The person finds it hard to keep still - they fidget and talk a lot. A smaller child may be continually jumping, running or climbing. They are restless and impulsive - interrupting others, grabbing things and speaking at inappropriate times. They have difficulty waiting their turn and find it hard to listen to directions. A person with this type of ADHD will have more injuries and/or accidents than others. A person whose symptoms include all those of 1 and 2, and whose symptoms are equally predominant. In other words, all the symptoms in 1 and 2 stand out equally ADHD cannot be diagnosed physically, i.e. with a blood test, urine test, brain scan or a physical check up. As most children have problems with self-control anyway, a proper diagnosis can be quite challenging. So how does one know if they have ADHD or not? The History of ADHD ADHD is the Result of
Chemical Imbalances in the Brain Left/Right Brain
Theory Hunter/Gatherer Theory Dietary Factors ADHD is a "Culture Bound Syndrome" Recent studies show that the brain chemical, dopamine, may play a role in ADHD.
Dopamine is an important chemical that carries signals between nerves in the brain.
It is linked to many functions, including movement, sleep, mood, attention, and learning.
Development of the cortical surface is delayed in frontal brain regions in children with ADHD. Theory that there is a functional disconnect syndrome and possibly one ‘stronger’ side of the brain.

All the parts are there but not all of them are connected correctly

Case study shows that in non-medicated male adhd patients there was a hypoactivation in the regions attributed to critical thinking. Work done by Thom Hartmann theorizing that there is a “gene” developed prompting a shift from the nomadic lifestyle.
“Emergence in the human genome seemed to coincide with some of the earliest documented examples of ancient people experimenting with agriculture”
Others have supported the theory calling for a shift in focus to positive easpects “response-ready, experience-seeking, and alert” going on to say that they would be more suited for active jobs like enterpluerse and soldiers
Some have critized this theory claiming it “is a silly little idea for building self esteem in ADHD children A recent Lancet study concluded that food dyes along with the preservative sodium benzoate (found in many soft drinks, fruit juices, & salad dressings) cause many children to become significantly more hyperactive and distractible
Many researchers consider chronic ADHD symptoms a sign of mild-moderate brain damage.
When regions of the brain are chronically inflamed it signals the primitive regions of the brain to be on overdrive.
This inhibits frontal lobe function which is the region responsible for concentration and emotional stability. Defined as a “recurrent, locality-specific pattern of aberrant behavior and troubling experience”
Generally, these syndromes occur in specific cultures.
The people with culture bound syndromes are seen as “deviating from the supposed cultural ‘norm’.”
First world counties can be considered to have a defined culture where things are very systematic and rule based, compared to the generally unruly structures of third world countries. Pediatrician Psychiatrist Process of Diagnosing Children with ADHD 1 hour process
PDM 13/14 hours
talk to patient
observe in classroom setting
play settings
psych test Treatment Options To medicate... Or not... A Few Quick Facts: Studies reveal that a person's risk of developing ADHD is higher if a close relative also has/had it.
Twin studies have indicated that ADHD is highly heritable.
Also, if one or both parents have ADHD, their children are more likely to develop the condition. Theories About ADHD ADHD is Genetic 460-370BC Following influenza and encephalitis
epidemic 1917-1920 1968 Diagnosis title changed to “hyperkinetic impulse disorder,” “hyperkinetic syndrome,” or “hyperkinetic disorder of childhood.”

Location of dysfunction at the thalamus (stimuli filter).

Theorized that there was an over activity of part of the brain. American Psychiatric Association (APA) publishes second edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-II) which includes disorders titled “hyperkinetic reaction of childhood,” or “adolescent and organic brain syndrome.” 1957 Multiple books published claiming diagnosis with ADHD-like symptoms were mythical and created by drug companies. 1975 APA publishes DSM-III. Includes “Attention Deficit Disorder,” (ADD) including subtypes: “ADD with hyperactivity,” “ADD without hyperactivity,” and “ADD residual type.” 1980 1993-1994 Hippocrates “The Father of Medicine” • 1st to recognize patients who showed “quickened responses to sensory experiences.”
• Described them as having an inability to stay focused “because the soul moves on quickly to the next impression.” 1775 Melchior Adam Weikard (German physician) •Wrote a chapter in Philosophisceh Arzt (medical textbook) on attention deficits.
•The chapter included symptoms that are currently linked with Inattentive type ADHD today.
•Suggested treatment included solitary confinement when the individual is too active. It also included treatments such as rubbing, cold baths, steel powder, cinchona 12, mineral waters horseback riding, and gymnastic exercises to calm the quickness. 1798 Sir Alexander Crichton (Scottish-born physician) •Wrote the book An Inquiry into the Nature and Origin of Mental Derangement.
•In the chapter titled “Attention,” he describes “mental restlessness.”
o Like Weikard, wrote of symptoms most closely associated with inattentive type ADHD.
o He observed that these symptoms can be seen at an early age and seems to diminish with age.
o He stated that these symptoms may be born with the person (biological) or from the effect of accidental diseases (environmental).
o He noted that his patients described their state of nerves as “the fidgets.”
o Suggested special education interventions to instruct children of such symptoms. 1845 Dr. Heinrich Hoffman (German Psychiatrist) •Wrote books on medicine, psychiatry, and children’s poetry.

•In his children’s poetry book Der Struwwelpeter (Shockhead Peter), a poem titled “The Story of Fidgety Philip” was about a young boy who had trouble sitting still or paying attention. Much like the modern day “Dennis the Menace.” Most closely associated with hyperactive type ADHD today. 1902 •In a series of lectures, which were later published in the British medical journal “The Lancet,” he described a group of children, who had serious problems with sustained attention and self-regulation. The children were aggressive, defiant, excessively emotional/passionate, resistant to discipline, and showed little inhibitory volition.

•Gave these symptoms a diagnostic name of “defect of moral control.”

•Noticed that these symptoms showed in three boys for every one girl.

•Also noticed this behavior to appear before age eight.

•He favored a biological predisposition (heredity) reason for this behavior and discovered that some of these children came from families with a history of depression, alcoholism, and conduct problems.

•His descriptions are closely associated with those of mixed type ADHD Sir George Frederick Still (Father of British Pediatrics) 1908 Alfred F. Tredgold (physician) •Described children who showed symptoms of inattention and high activity as “high-grade- feeble minded.”
•Theorized that cause was from brain damage •Survivors of this disease displayed symptoms commonly associated with ADHD of today.
•Cause of symptoms associated with brain damage. Diagnosis titles included “post-encephalitic behavior disorder,” “brain-injured child syndrome,” “minimal brain damage,” “minimal brain dysfunction.” -1993 Dr. Russell A. Barkley begins publishing “The ADHD Report Newsletter.”

-1994 APA publishes DSM-IV including ADHD with three subgroups. ADHD Predominantly Inattentive Type, ADHD Predominantly Hyperactive-Impulsive Type, and ADHD Combined/Mixed Type

•Revised again in 2000 to DSM-IV-TR, to reflect changes in recent research, and is the current diagnosis tool for ADHD today. Children comprise the majority of ADHD diagnoses, but because they are unable to give informed consent due to their age, treatment decisions are ultimately determined by their legal guardians on their behalf. When are we treating the patient vs. when are we treating the parent? Based on the information given, do you think ADHD is fact or fiction? How should we tailor school systems to children diagnosed with ADHD? (Seperate classrooms, seperate schools, etc.
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