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)

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…”

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

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

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

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

Dennis the Menace

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

Home Alone 2

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

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

Good Will Hunting

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.)

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

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

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

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

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

Sound of Music

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

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

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.

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;31:416-425. Biederman J et al. Am J Psychiatry. 1993;150:1792-1798.

Officer and A Gentlemen

ADHD Comorbidity in Adults with Other Psychiatric Disorders Disorder ADHD Rate Major Depression1 20% Bipolar Disorder2 15% Generalized Anxiety Disorders3 20% Substance Abuse4 25% 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. 1996. 2. Nierenberg et al. APA Presentation. 2002. 3. Fones et al., J Affective Dis; 2000 4. Wilens. Psych Clin N Am; 2003.

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

Mrs. Doubtfire

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.

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

Sound of Music

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

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

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

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

Lion King

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

?ADULT ADHD SYMPTOMS