1. Carolyn R. Fallahi, Ph. D. Attention Deficit Hyperactivity Disorder

2. Introduction Case Studies in ADHD. Symptom presentation. History of ADHD Nursery rhyme presented in your book by Henrich Hoffman, a German psychiatrist, (mid 1800s). Phil, stop acting like a worm; The table is no place to squirm; Thus speaks the father to his son. Severely says it, not in fun. Mother frowns and looks around; Although she doesn’t make a sound; But Phillip will not advise; He’ll have his way at any price; He turns; And churns; He wiggles; And jiggles; Here and there on the chair; Phil, these twists I cannot bear.

3. History 1902: George Still (Royal College of Physicians): restlessness, inattentiveness, and overarousal in children. 20 th Century: encephalitis lethargica – epidemic in America and Europe. Led to the idea that ADHD was neurologically based. Postencephalitic Behavior Disorder. Minimal Brain Dysfunction. Hyperkinetic Impulse disorder (DSM II diagnosis). Attention Deficit Disorder (DSM III diagnosis). Attention Deficit Hyperactivity Disorder (ADHD; DSM-IIIR 1987).

4. ATTENTION-DEFICIT/HYPERACTIVITY A. Either (1) or (2): (1) 6 or more of following have persisted for 6 months to degree that is maladaptive and inconsistent with developmental level: Inattention ____ ____ often fails to pay attention to details or makes careless mistakes in school or other activities ____ ____ often has difficulty sustaining attention ____ ____ often does not seem to listen when spoken to directly ____ ____ often doesn't follow through on instructions and fails to finish things ____ ____ often has difficulty organizing tasks and activities ____ ____ often reluctant to do things requiring sustained mental effort ____ ____ often loses things ____ ____ easily distracted ____ ____ often forgetful

5. 2) 6 or more of following have persisted for 6 months to degree that is maladaptive and inconsistent with developmental level: Hyperactivity ____ ____ often fidgets with hands or feet or squirms in seat ____ ____ often leaves seat in class ____ ____ often runs or climbs excessively in inappropriate situations ____ ____ often has difficulty playing quietly ____ ____ often "on the go" or acts as if "driven by a motor" ____ ____ often talks excessively Impulsivity ____ ____ often blurts out answers before question completed ____ ____ often has difficulty awaiting turn ____ ____ often interrupts or intrudes on others B. ____ ____ Some symptoms present before age 7 C. ____ ____ Some impairment present in 2 or more settings D. ____ ____ Symptoms do not occur exclusively during Pervasive Developmental Disorder, Schizophrenia, are not better accounted for by depression or anxiety

6. Subtypes of ADHD Attention Deficit Hyperactivity Disorder – Predominantly Inattentive Type Attention Deficit Hyperactivity Disorder – Predominantly Hyperactive-Impulsive Type Attention Deficit Hyperactivity Disorder – Combined New subtype: Sluggish Cognitive Tempo

7. Controversies and Unresolved Issues The issue involving the diagnosis of ADHD, inattentive type. What is normal versus clinical? ADHD diagnosis and age.

8. Epidemiology Prevalence: 3-5% children; 2-3% adolescents. Cultural issues? Gender differences: seen more in boys 6-9x. Co-occurring disorders: Conduct disorder Depression. Bipolar Disorder. Anxiety Disorders. Learning disorders

9. Co-morbidity

10. Additional problems for patients with ADHD Intelligence and academics Problems with family and peer relationships Emotional dysregulation Sleep and health problems

11. Developmental course of ADHD Problems across the lifespan

12. Etiology of ADHD Genetic explanations Neurological explanations Structural problems within the brain Neurotransmitters Prenatal explanations Social explanations

13. Treatments for ADHD

14. Stimulants and ADHD Mechanism of action Common Stimulants used to treat ADHD