22/10/2018 ADHD and Common Issues Across the Life-Span Sophie Godbout-Beaulieu, R.Psych Leslie MacIntyre, R.Psych Harpreet Aulakh, R.Psych What is ADHD? (DSM-V) A. Persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by symptoms of Inattention (1) and/or (2) Hyperactivity/Impulsivity. B. Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years. C. Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (e.g., at home, school, or work; with friends or relatives; in other activities). D. There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning. 1
22/10/2018 (1) Inattention Often fails to give close attention to details or makes careless mistakes Often has difficulty sustaining attention in tasks or play activities Often does not seem to listen when spoken to directly Often does not follow through on instructions and fails to finish tasks Often has difficulty organizing tasks and activities Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort Often loses things necessary for tasks or activities Is often easily distracted by extraneous stimuli Is often forgetful in daily activities (2) Hyperactivity/Impulsivity Often fidgets with or taps hands or feet or squirms in seat Often leaves seat in situations when remaining seated is expected Often runs about or climbs in situations where it is inappropriate (teens/adults = restless feeling) Often unable to play or engage in leisure activities quietly Is often “on the go,” acting as if “driven by a motor” Often talks excessively. Often blurts out an answer before a question has been completed Often has difficulty waiting his or her turn Often interrupts or intrudes on others 2
22/10/2018 ADHD In Children Interrupts the “Immature” Losing mittens, water Screen Time Argumentative teacher bottles, hats Rushing through schoolwork Messy Rushing Forgets to brush Difficult to toilet Scraped knees, teeth train random bruises Climbing on Easily Frustrated Refusal/non everything Wanting immediate compliance Difficulty making rewards Avoids homework and keeping friends Anxiety Disorder Delays in executive functioning Relationship Issues Mood Disorders (e.g, Trauma Depression) Attachment Disorder Learning and/or Intellectual Disability Family Dynamics Neurodevelopmenta Conduct/Oppositional l Disorders (e.g., ADHD Defiant Disorder ASD, Tourette's) 3
22/10/2018 Mary (10 years) Mary has a school project due tomorrow morning. She is realizing that she has not yet started working on it and does not know where to start. Her parents often find it necessary to sit down with her to help her complete her homework, otherwise, she tends to be overwhelmed with the amount needing to be done. They are getting frustrated because they feel like they have to hold her by the hand to complete every little step…even reminding her to bring her cleats along for soccer practice. Every. Single. Time. At school, it often takes Mary longer than most of her classmates to finish her work. She is easily distracted (“Oh! Liam sneezed…I hope I don’t get sick! My nose is runny too. I need to use the bathroom. I hope my friend Kennedy will be there too this time! Oh I can’t go someone already took the pass. Now what was I doing again?”) and often forgets to bring the right material along. Mary is becoming more and more aware of her differences and she is starting to worry about being able to keep up with the others. Recently, she’s been having a hard time falling asleep, often crying and thinking “What’s wrong with me? I’m stupid.” Marco (10 years) Marco loooooooves Fortnite. He spends hours upon hours watching Ninja (the famous player), learning the right moves, and of course, practicing his dance moves. When his parents suddenly tell him that it is supper time and that he needs to stop playing, a meltdown is also usually on the evening’s menu. It is so hard for Marco to stop playing, let alone with such little warning (in fact, he didn’t really hear the other 5 reminders). At school, Marco is the class clown. He gets along well with his classmates, but will sometime say hurtful comments without realizing the impact on his friends. He then feels guilty about it all. His teacher constantly has to remind Marco to sit still, be quiet, and to just please listen for more than 60 seconds. His favourite subject is gym – finally, a time where he doesn’t have to sit still! 4
22/10/2018 Common presentation in childhood • Caregivers typically start noticing differences when children are between 3-4 years. Preschool School-aged • overly active • difficulty sustaining • mischievous attention and effort non- compliant with parents’ impulsivity • • requests • restlessness • difficult to toilet train • non-compliance • possible delays in school • poor school performance readiness • learning disorders in a significant minority of children with ADHD 5
22/10/2018 • Tend to have lower ratings on hyperactivity, inattention, impulsivity, and externalizing ( = “acting - out”) problems Greater intellectual impairments • • More internalizing (ex: depression, anxiety) problems • Relational aggression than non ADHD peers Studies find a real difference in severity • and presentation between genders • May be more subtle and less evident by adults observers; referral bias. Contributing factors to symptom presentation 6
22/10/2018 • Reliable and valid diagnosis can be made for children as young as 3.5 years. • Developmental history, parents’ interview, teachers’ interview, rating scales, and psychoeducational testing. • eToolKit Form by Canadian ADHD Resource Alliance (CADDRA). 7
22/10/2018 ADHD in Teens “Irresponsible” Arguing/Fighting Losing phone, keys, books, Screen Time “Unmotivated” assignments, etc. Not doing/finishing chores “Lazy” and/or homework Messy Rushing Failing/dropping out Late Injured often Contact with the law Easily Frustrated Refusal/non Consequences/rewards compliance Procrastinating/ don’t seem to help Difficulty making Avoiding and keeping friends Anxiety Disorder Psychotic Disorder Relationship Issues Substance Use Mood Disorders Trauma (e.g., Bipolar, Attachment Disorder Depression) Learning and/or Intellectual Disability Family Dynamics Neurodevelopmenta Conduct/Oppositional l Disorders (e.g., ADHD Defiant Disorder ASD, Tourette's) 8
22/10/2018 Mary (16 years) It’s a school morning. Mary’s parents wake her up. She says good morning and then and stays in bed day dreaming. Her parents call her a few more times before she realizes she is late and gets up. She begins to rush around. She loses track of time in the bathroom thinking about the new make up she wants to buy and worrying about the project she did last minute that is due today. She can’t find a brush so she uses her fingers. She can’t find a clean shirt or her socks because all her clothes are on the floor, so she wears the first things she sees. Her parents call up to remind her to take her dishes from her room to the kitchen (which she didn’t do yesterday). She gets a text message on her way to the kitchen. She is afraid she will forget what she wants to tell her friend or even to reply so she does it right away. Her friends have been mad at her for “ignoring” them in the past. Her parents get frustrated when they see her on her phone (“You don’t have time to talk to your friends. You are always late. You need to get moving!”). Mary feels sad because she knows she is always late “no matter what she does”. She ends up leaving the dishes in the living room. She begins to worry about being late again for school and getting in trouble. In her rush to leave, she walks out of the house without her lunch, homework or glasses/contacts. Mary (16 years) At school, the classroom is loud and there are many conversations going on. She can’t find a pen and realizes that she has the wrong binder (this is math, not geography). She has trouble listening to the teacher because the student behind her is coughing, moving around, and talking to their neighbour. She then starts talking to her friend. The teacher moves her to another seat. Her classmates tease her. She feels embarrassed and ashamed. She begins to day dream. Her day dreams are interrupted by the bell at the end of the lesson. She does not remember what the topic of the class was that day. She arrives at her next class only to realize she has a test that day and the assignment she forgot at home (which she rushed to finish) is due next week. She has thoughts such as “I’m going to fail”, “I’m a stupid screw up”, “I can’t do anything right” and “Everyone else remembered there was a test. There is something wrong with me”. 9
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