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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)

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Presentation on theme: "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)"— Presentation transcript:

1 ADHD THROUGH THE MOVIES 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 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 Common Adult Manifestation Workaholic Overscheduled/overwhelm ed Self-selects a very active job Constant activity leading to family tension Talks excessively Hyperactivity often changes to inner restlessness

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 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 Impulsivity in adulthood often carries more serious consequences

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18 ADHD Impairment Persists Adulthood      Childhood Hopelessness, frustration, giving up Repetitive failure Unwanted pregnancy, sexually transmitted disease, etc Impulsivity, carelessness Antisocial personality disorder, criminality Oppositional defiant or conduct disorder Drug dependenceDrug experimentation Fatal car wrecks or risk taking Multiple injuries Job failure or underemployment Becomes School failure or underachievement 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) 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 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

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%) 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 1 20% Bipolar Disorder 2 15% Generalized Anxiety Disorders 3 20% Substance Abuse 4 25% 1. Alpert et al. Psychiatry Res Nierenberg et al. APA Presentation Fones et al., J Affective Dis; Wilens. Psych Clin N Am; Re-evaluate refractory patients for ADHD

27 Domains of Impairment Impairments Academic/ Occupational Health/Injury Substance Abuse Sexual Behavior Criminality Social Functioning Self-esteem

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 ADHD Low self esteem Academic limitations Relationships Smoking and substance abuse Injuries Motor vehicle accidents Legal difficulties Occupational/ vocational Children Adults Adolescents Potential Areas of Impairment

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


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