1. ADHD THROUGH THE MOVIES www.adhdclinicjeeva.com
DR SHABEER JEEVA
CHILD AND ADULT
PSYCHIATRIST
LRCP, LRCS(IRELAND), D.PSYCH(OTTAWA),
F.R.C.P(CANADA)

2. Patients with “ADHD” may suffer Because…..
Their parents don’t understand them;
Their teachers can’t stand them;
Their peers reject them;
Their spouses and bosses can’t stand their disorganization and intensity;
They themselves begin to think: “no matter what I do I can’t win…”

3. Famous People with Attention Deficit and Learning Disorders
Albert Einstein
Thomas Edison
Gen. George Patton
John F. Kennedy
Bruce Jenner
Eddie Rickenbacker
Harry Belafonte
Walt Disney
Steve McQueen
George C. Scott
Tom Smothers
Suzanne Somers
Jules Verne
“Magic Johnson”
Carl Lewis
Nelson Rockefeller
Sylvester Stallone
Cher
Gen. Westmoreland
Charles Schwab
Danny Glover
John Lennon
Greg Louganis
Winston Churchill
Henry Ford
Robert Kennedy
George Bernard Shaw
Beethoven
Hans Christian Anderson
Galileo
Mozart
Leonardo da Vinci
Whoppi Goldberg
Tom Cruise
Henry Winkler
F. Scott Fitzgerald
Robin Williams
Louis Pasteur
Werner von Braun
Dwight D. Eisenhower
Lindsay Wagner
Alexander Graham Bell
Woodrow Wilson

4. ADHD Diagnosis 5-9% children with this condition
60% of these children go on to adulthood with impairing symptoms
Core symptoms are
Impulsivity
Attentional problems
Motor hyperactivity

5. Visual Images
Move in the academic teaching arena to use movies and visual processes as ways of teaching
ADHD patients respond better to visual systems rather than talking
Auditory processing problems
Strengths in visual-spatial ability
Ability to see the forest but not the trees

6. Impulsivity An urge that is difficult to resist Dennis the Menace
The Simpsons

7. Dennis the Menace

8. Inattention Loss of order and loss of presence of mind Home Alone
Inspector Gadget
Gilligan’s Island
Get Smart

9. Home Alone 2

10. Motor Hyperactivity Any movie by Jim Carrey Robin Williams
Howie Mandell
Tom Cruise

11. ADHD-Developmental
You must accept that if ADHD is a lifelong disorder, then your personality must change. The Adult is still having power battles with authority figures which is similar to the power battles within themselves.
Different Examples
-Officer and a Gentleman
-Goodwill Hunting
-The Lion King
-Mrs. Doubtfire

12. Good Will Hunting

13. ATTENTION DEFICIT DISORDER
A.D..D.
IMPULSIVITY
Failure to think of
Consequences before
acting
“Combined”
ATTENTION
= DISTRACTIBILITY
Trouble holding focus
A.D.H.D.
+ OVERACTIVITY
(easily bored/excess energy.)

14. Symptoms of Hyperactivity Often Manifest Differently in Adults
Hyperactivity often changes to inner restlessness
Common Adult Manifestation
Workaholic
Overscheduled/overwhelmed
Self-selects a very active job
Constant activity leading to family tension
Talks excessively
DSM-IV Symptom Domain
Squirms and fidgets
Can’t stay seated
Runs/climbs excessively
Can’t play/work quietly
“On the go”/driven by motor
Talks excessively

15. Symptoms of Inattention Often Manifest Differently in Adults
DSM-IV Symptom Domain
Difficulty sustaining attention
Doesn’t listen
No follow-through
Can’t organize
Loses important things
Easily distractible, forgetful
Common Adult Manifestation
Difficulty sustaining attention
Meetings, reading, paperwork
Paralyzing procrastination
Slow, inefficient
Poor time management
Disorganized

16. Symptoms of Impulsivity Often Manifest Differently in Adults
Impulsivity in adulthood often carries more serious consequences
DSM-IV Symptom Domain
Blurts out answers
Can’t wait turn
Intrudes/interrupts others
Common Adult Manifestation
Low frustration tolerance
Losing temper
Quitting jobs
Ending relationships
Driving too fast
Addictive personality

18. ADHD Impairment Persists
Childhood
Adulthood
  
School failure or underachievement
Becomes
Job failure or underemployment
Multiple injuries
Fatal car wrecks or risk taking
Drug experimentation
Drug dependence
Oppositional defiant or conduct disorder
Antisocial personality disorder, criminality
Although ADHD impairment persists into adulthood and “simply” changes form, consequences worsen. The results can end up “going on permanent record.”
Example: Consequences of ADHD impairment are significantly different for an 8-year-old boy who rides his bicycle into a tree and a 28-year-old man who drives his car into that same tree.
Impulsivity, carelessness
Unwanted pregnancy, sexually transmitted disease, etc
Repetitive failure
Hopelessness, frustration, giving up
Courtesy of W. Dodson, MD

19. Diagnosis of ADHD in Adults: Common Clinical Histories
Difficulties in Elementary or Secondary School
Comments: “not living up to potential,” “spacey,” “hyper”
Behavioral issues: “class clown”
Difficulties in College
Incomplete degree or longer time to complete degree
Difficulty engaging in further education
Difficulties at Work
Underachievement (mixed reviews)
Low efficiency: 4 times longer to complete tasks
Difficulties at Home
Poor organization, does not complete tasks
Strained relationships with spouse and kids (who also may have ADHD)
Listed here are some cues for eliciting lifelong symptoms in the diagnostic process to establish the presence or absence of ADHD.
Courtesy of T. Wilens, MD

20. Sound of Music

21. Office Presentation Patients with ADULT ADHD:
Are forgetful or “airheads”
Miss appointments or arrive late
Lose prescriptions
Do not carry out instructions or the treatment plan
Are hypertalkative
Are “passionate” or have emotional storms triggered by events

22. ADHD and Comorbid Conditions
Impulsivity/
Hyperactivity
Inattention
In the diagnostic assessment of ADHD it is important to address possible co-occurring psychiatric disorders, referred to as comorbidity, as they may influence treatment and outcome.
ADHD is frequently comorbid with other psychiatric disorders. These include disruptive behavior disorders, mood disorders, anxiety, and learning disorders.
Comorbidity

23. Clinical Presentation
Multiple mental health consultations
Multiple jobs
Stormy relationships
Trouble with authority figures; arrest record
Family history of bipolar disorder, substance abuse, or Tourette syndrome
Family history of ADHD
Performance and mood determined by interest and challenge
Most adults with ADHD have had several previous mental health consultations—involving comorbidities, relationship difficulties, and mood-regulation problems—and yet other clinicians have missed the diagnosis.
Many adults with ADHD have had multiple jobs and careers; most commonly, they change jobs out of boredom rather than as a result of overt failure.
In cases in which ADHD is accompanied by oppositional defiant disorder, the patient’s life is often marked by conflict with authority figures of all types—teachers, coaches, bosses, and so forth.

24. Comorbid Psychiatric Disturbances Are Common in Adults With ADHD
Antisocial Disorder (10%)
Major Depressive Disorder (35%)
Bipolar Disorder (15%)
Anxiety Disorders (40%)
Substance Abuse Disorders (50%)
These rates indicate the presence of particular disorders over the lifetime of adults with ADHD.
Shekim WO et al. Compr Psychiatry. 1990;31:
Biederman J et al. Am J Psychiatry. 1993;150:

25. Officer and A Gentlemen

26. ADHD Comorbidity in Adults with Other Psychiatric Disorders
Disorder ADHD Rate
Major Depression %
Bipolar Disorder %
Generalized Anxiety Disorders %
Substance Abuse %
Many practitioners question if they have ever seen an adult with ADHD. In fact, given the high incidence of ADHD in adults with a myriad of other psychiatric conditions, they have indeed seen these adults.
If you start with:
Major depression- 20% also have ADHD
In Bipolar disorder, evidence suggests that the earlier the onset of bipolarity, the more likely the individual is to also have comorbid ADHD.
Anxiety- 20% also have ADHD
Substance Abuse- 25% of patients for treatment have childhood onset and current ADHD
Re-evaluate refractory patients for ADHD
1. Alpert et al. Psychiatry Res
2. Nierenberg et al. APA Presentation
3. Fones et al., J Affective Dis; 2000
4. Wilens. Psych Clin N Am; 2003.

27. Academic/ Occupational
Domains of Impairment
Health/Injury
Academic/ Occupational
Impairments
Substance Abuse
Self-esteem
Sexual Behavior
These are areas in which ADHD can have significant impact and cause a high level of impairment.
Social Functioning
Criminality

28. Mrs. Doubtfire

29. ADHD Owners Manual
Many people with ADHD don’t realize they have an owner's manual. We help them to learn about themselves. This is the way you are.
---How to maximize your strengths and minimize your weaknesses.
It helps people look at themselves in a more positive way and to learn why things have happened.

30. Potential Areas of Impairment
ADHD
Low self
esteem
Academic
limitations
Relationships
Smoking and
substance abuse
Injuries
Motor vehicle
accidents
Legal
difficulties
Occupational/
vocational
Children
Adults
Adolescents
Academic failures and poor socialization occur frequently in young children with ADHD
Poor judgment and inattention in adolescents and adults result in increasing incidence of legal difficulties, substance abuse, injuries, motor vehicle accidents, and occupational difficulties in patients with the disorder

31. Sound of Music

32. Pharmacotherapy in Adults
Stimulants
Methylphenidate-Ritalin
Amphetamine compounds-Dexedrine
Magnesium pemoline (not recommended)
Long acting stimulants -Ritalin-SR.Ritalin-L.A,Concerta,Adderal XR
Atomoxetine (FDA-approved in adults)-Straterra
Antidepressants
Bupropion-Welbutrin SR
SSRI/SNRI
Tricyclics
Other
- Mood Stabilizers: Valproic Acid/Lithium
- Atypical Antipsychotics: Resperidone
- Clonidine
Research
Modafinil

33. ATTENTION DEFICIT DISORDER Effects of Medication
IMPROVES:
Compliance
Following the rules
Percentage of seat work completed
Accuracy of seat work
Teachers’ rating of behaviour
Performance on cognitive laboratory tasks
Handwriting
Central auditory processing testing
Positive attention from mothers

34. ATTENTION DEFICIT DISORDER Effects of Medication
DECREASES:
Fidgeting
Impulsivity
Negative social behaviours
Vocalizations and noise
Controlling behaviour of mothers and teachers
Intensity of interactions by teachers
Off-task behaviour in class

35. ADHD, ODD and CD Integrative Interventions
Preventative interventions (i.e. preventing the development of comorbid disorders)
Patient, parent, spouse training and support
Individual counseling and therapy
Group counseling and therapy
Family counseling and therapy
Interventions at school and work place
Medication eg. Resperidone
Working with correctional systems
Turgay (2001), The World of Children # 4, Winter 2001 pp:9-28

36. Lion King

37. Conclusions ADHD symptoms are impairing
The symptoms continue into adulthood
Early problems of attachment lead to a false sense of self
Insight to the clinical symptoms has profound implication to treatment and compliance

38. ?ADULT ADHD SYMPTOMS