Attention Deficit Hyperactivity Disorder (ADHD)

Definition

• Attention deficit hyperactivity disorder; a disorder characterized by a persistent pattern of inattention and/or hyperactivity. ADHD is based on a series of inattention and hyperactivity symptoms/behaviors outlined in the Diagnostic & Statistical Manual for Mental Disorders (DSM-IV).

Symptoms

• Symptoms that cause the impairment must be:– Present before age seven– Present in more than one setting. For instance,

the person may be impaired at home and school or home and work.

– Interfering with the person's ability to function at school, home, in social environments, or in work environments.

Factors in ADHD

• Attention Deficit Hyperactivity Disorder has two distinct factors:– Inattention– Hyperactivity-impulsivity

• Symptoms must be present for at least six months to a degree that is maladaptive (counterproductive or highly inappropriate) and inconsistent with developmental level before a diagnosis can occur.

Types of ADHD

There are three different types of ADHD, including:

• Combined ADHD (the most common type), which involves all of the symptoms.

• Inattentive ADHD (previously known as ADD), which is marked by impaired attention and concentration.

• Hyperactive-impulsive ADHD, which is marked by hyperactivity without inattentiveness.

Inattention & Hyperactivity-impulsivity

• Inattentive students with ADHD are daydreamers, who are often forgetful and easily distracted.

• Hyperactive-impulsive students with ADHD have difficulty sitting still, talk out of turn, are combative with parents and teachers, and more likely to develop oppositional and defiant disorder or conduct disorder in adolescence.

Inattention Behaviors

• Difficulty paying attention to details and tendency to make careless mistakes in school.

• Easily distracted by irrelevant stimuli and frequently attending to trivial noises or events that are usually ignored by others.

• Not listening to others, even when spoken to directly.

• Not keeping one's mind on conversations.

Hyperactivity Behaviors

• Fidgeting and/or squirming when seated. • Getting up frequently to walk or run around. • Running or climbing excessively when it's

inappropriate. • Difficulty playing quietly or engaging in quiet

leisure activities. • Being always on the go. • Often talking excessively.

Impulsivity Behaviors

• Impatience • Difficulty delaying responses • Difficulty awaiting one's turn • Frequently interrupting • Intruding on others to the point of causing

problems in school, social, or work settings.

ADHD (continued) • 85% of students with ADHD have a combination of

Inattention and Hyperactivity-impulsivity (Vaughn, Bos, & Schumm, 2007).

• Students with the combined type of ADHD are generally more like students with hyperactive-impulsive ADHD.

IDEA & ADHD• IDEA does not recognize ADHD as a separate

category of disability. Instead, students with ADHD may be eligible for special education and related services through IDEA as “Other health impairment ” or Section 504.

• “Other health impairment” means having limited strength, vitality, or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment.

Other Health Impairment (OHI) OHI also includes:• Asthma• Diabetes• Epilepsy• Hemophilia• Lead poisoning• Leukemia;• Sickle cell anemia; and• Tourette syndrome;

What causes ADHD?

• ADHD tends to run in families (it can be passed on genetically), other factors such as low birth weight, prenatal maternal smoking, or other prenatal problems like head injuries, particularly an injury to the frontal lobe (Vaughn et al., 2007).

ADHD & Medication

Genes that control the levels of certain chemicals in the brain called neurotransmitters seem to be different in those with ADHD.

(i) Stimulant medications helps 70-80% of students with ADHD focus/concentrate. Ritalin is the most frequently prescribed stimulant drug for ADHD.

(ii) Antidepressants

Examples of Stimulants

Stimulant drugs to treat ADHD include:• Adderall • Concerta • Cylert• Dexedrine • Focalin • Metadate• Methylin

Antidepressants• Antidepressant medications for ADHD are used when

stimulants are not effective, or when anxiety and/or depression in students with ADHD.

• Clonidine belongs to a class of drugs (central alpha agonists) that act in the brain by relaxing blood vessels so blood can flow more easily. – Clonidine is prescribed off label for ADHD. – Off-label use is the practice of prescribing pharmaceuticals

for a purpose outside the scope of a drug's approved label.

Strattera is the only non stimulant approved by the FDA to treat attention deficit hyperactivity disorder.