ADHD: What is it?
Presented at a Public Forum in Singapore on 2 June 2007 ADHD: What is it? Rosemary Tannock, PhD Professor & Canada Research Chair in Special Education,University of Toronto; Senior Scientist, Sickkids Hospital, CANADA 1 TeachADHD/Singapore/2007 ADHD: Some Questions and Answers What is ADHD? Why does my child have it? What does ADHD mean for my child? – Academic and social impact of ADHD What does ADHD mean for my family? – Challenges for parenting Why is it important to seek help and support? – Lifespan perspective of untreated ADHD 2 TeachADHD/Singapore/2007 What is Attention-Deficit/Hyperactivity Disorder (ADHD)? It is a medical term given to children (adolescents, adults), who exhibit a persistent , developmentally inappropriate, and impairing pattern of behavior, such as… – Problems paying attention, distractible – Interrupting and intruding upon others – Fidgeting, squirming in seat 3 TeachADHD/Singapore/2007 ADHD: Medical definition Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurobiological condition that becomes apparent in the preschool and early school years Main Characteristics: Inattention Hyperactivity Impulsivity : An Neurobiological disorder illness of the nervous etic, system caused by gen ctors. metabolic, biological fa Many ‘mental’l’ health problems are , neurobiological (ADHD autism, schizophrenia) Characteristics of a child with ADHD • Often moves more quickly into a state of high agitation or excitement than other children • Often talks incessantly and loudly, is constantly moving, and frequently switches from one activity to another without pause • Cannot filter out unimportant stimuli – everything grabs his or her attention • Annoys everybody and cannot help it • Is disliked by others and may realise this • Has low self-esteem and often dislikes himself/herself • Is often remorseful after behaving ‘badly’, saying ‘I can’t help it’ • Demonstrates this behaviour in a persistent and enduring way ADHD is very common! 5.27% children & adolescents, worldwide 1-2 students per class 4% adults Male: female ~ 3:1 [but in adults ~ 1:1] Skounti et al (2007) Eur J Pediatr. 166(2):117-23. . Faraone et al (2003) World Psychiatry 2:104-113; Kessler et al (2005) Arch Gen Psychiatry 62:617-627 ADHD has been recognized in medicine for a long time! “Fidgety Phil” “Johnny-Head-InThe-Air” 1845 Dr. Heinrich Hoffman “a defect of moral control - of biological origin” 1902 Dr. George Still TeachADHD/Singapore/2007 ADHD is a ‘hidden’ disability Individuals with ADHD do not look different, but they behave differently: – Do not respond to typical parenting & so make family life quite stressful – Do not respond to typical classroom management and so may disrupt the class and interfere with the process of teaching 8 TeachADHD/Singapore/2007 2 clusters of behavioral symptoms 3 subtypes of ADHD INATTENTIVE SUBTYPE INATTENTION “ADD” HYPERACTIVEHYPERACTIVITYIMPULSIVE SUBTYPE IMPULSIVITY COMBINED TYPE “Classic ADHD” 9 5 TeachADHD/Singapore/2007 Inattention Hyperactivity Impulsivity Easily sidetracked & unable to filter out distractions Inability to concentrate Inability to sit through a lesson Disorganized & forgetful Constant fidgeting, fiddling Acting before thinking Inability to Roaming around a room wait one’s turn Butting in and interfering with others Attention Problems: at least 6 of 9 symptoms 1. Poor attention to details, makes careless mistakes 2. Difficulty concentrating 3. Doesn’t seem to listen 4. Fails to follow through on instructions & finish work 5. Difficulty organizing work and self 6. Avoids, dislikes lengthy, effortful tasks 7. Loses things Persistent (> 6 months) 8. Easily distracted Pervasive (> one setting) 9. Forgetful Impairing Manifestation of ADHD symptoms of inattention in school • Difficulty organizing work & self • Papers misfiled or pushed into bag; locker, desk, backpack in constant disarray • Easily distracted • Constantly looking around at what others are doing or what is going on; head on a swivel; activity or noises in classroom pull student away from work • Frequently loses things • Constantly hunting for needed items (pencil, book etc) Hyperactivity/Impulsivity problems at least 6 of 9 symptoms Hyperactivity 1. Fidgets, squirmy 2. Leaves seat inappropriately 3. excessive running, climbing 4. difficulty playing quietly 5. on the go, driven 6. talks excessively Impulsiveness 7. blurts out 8. can’t wait turn 9. interrupts, intrudes Persistent (> 6 months) Pervasive (> one setting) Impairing Manifestation of ADHD symptoms of hyperactivity/impulsivity in school • Constantly on the go • Frequently rocks chair, • Difficulty remaining seated (when it is expected) stands up or leans over desk, swings legs, shifts in seat, rarely stops moving • Wanders around classroom; frequently stands instead of sitting at desk • Difficulty awaiting turn • Does not wait to be called on but shouts out answer; gets frustrated & disruptive when has to wait in line ADHD differs in boys and girls (Abikoff et al., 2002; Biederman et al., 2002; Rucklidge & Tannock, Tannock, 2002; Tannock, Tannock, 2004) Girls are : 15 less likely to exhibit disruptive behavioral symptoms of ADHD as likely to exhibit covert symptoms of ADHD as impaired cognitively, academically, socially more likely to exhibit covert, verbal aggression TeachADHD/Singapore/2007 ADHD persists into adolescence & adulthood: but changes in its behavioral manifestation Impul Hyp sivity erac tivit y Diagnostic level Sub-threshold but impairing levels Normal levels childhood adolescence adulthood 50%-75% cases 50-75% cases TeachADHD/Iceland/2006 ADHD looks somewhat different in adolescents Inner mental restlessness, rather than observable high activity – Tend to want to be constantly doing something Disorganization, poor time management & problems concentrating – Rarely has books, materials needed for class – Major problems with completing assignments on time – Great difficulty listening to and taking notes during a lecture 17 TeachADHD/Singapore/2007 Symptoms vary within a child minute-to-minute, day-to-day, & from one situation to another Symptoms increase during activities with: – high cognitive demand – little active engagement 18 TeachADHD/Singapore/2007 ADHD look-alikes Many children experience behavioural symptoms of ADHD for reasons other than ADHD – stressful or worrying events – Dyslexia or other specific LD – Brain injury, FAS, language weaknesses 19 Doctors “rule-out” other medical explanations before they confirm that the problems are due to ADHD TeachADHD/Singapore/2007 ADHD – Why does my child have it? Is it my fault? Is it because of my parenting? Is it too much sugar or junk food? Is it because my child is just naughty or lazy? 20 TeachADHD/Singapore/2007 ADHD: It is nobody’s fault! It is not shameful for the family or child It is often inherited – runs in families – just like height, vision problems, dyslexia But it makes life tough for the individual with ADHD and the family! So seek help! 21 TeachADHD/Singapore/2007 What causes ADHD? Multiple factors but we don’t know how they fit together! Neuroanatomic Neurochemical1 Genetic origins 2-4 ADHD Environmental factors3,5 1. Swanson J, et al. Curr Opin Neurob iol 1998; 8:263271. 2. Hauser P, et al. N Engl J Med 1993; 328:997-1001. 3. Swanson JM, et al. Mol Psychiatry 1998; 3:38-41. CNS insults5,6 4.Swanson JM, et al. Lancet 1998; 351:429-433. 5. Milberger S, et al. Biol Psychiatry 1997; 41:65-75. 6. Castellanos FX, et al. Arch Gen Psychiatry 1996; 53:607-616. ADHD is heritable & runs in families Highly heritable Average genetic contribution of ADHD based on twin studies = 0.8 (Asthma = 0.4) Faraone. J Am Acad Child Adolesc Psychiatry. 2000;39:1455-1457 If one child in family has ADHD, often one of the other siblings has ADHD Biederman et al: Arch Gen Psychiatry 1992; 49:72838 If a child has ADHD, often one of the parent has ADHD Faraone & Biederman: Biederman: Harvard Rev Psychiatry 1994; 1:271-87 Chronis et al: JAACAP 2003, 42:1424-1432 Tannock/OASAR/April 2006 ADHD Hyperactivity Impulsivity Inattention Behavior symptoms of ADHD are just the tip of the iceberg! TeachADHD/Singapore/2007 Brain structure & function in ADHD Castellanos et al: JAMA 2002; Durston et al., JAACAP 2004; review by Tannock 1998) Overall brain volume 3% smaller in ADHD Decreased prefrontal volume & activation (particularly R hemisphere) Smaller R cerebellar volume & smaller vermis lobules VII-X [corrected for brain size] Adapted from Castellanos: ACNP 2002 TeachADHD/Singapore/2007 Brain differences in ADHD occur in regions that are important for attention, self-regulation, and learning Frontal lobe: control attention & resist distraction. Parietal lobe: visual-spatial information Cerebellum: exact timing & coordinating movement other areas: Corpus callosum: exchanges information between brain’s hemispheres Corpus striatum: motor control & reward mechanisms TeachADHD/Singapore/2007 R. Tannock: HSC Toronto/ Public Education Program: Kelowna, British Columbia (Nov 2005) Environmental factors in ADHD Prenatal exposure to nicotine – Maternal smoking, second-hand exposure Prenatal exposure to other neurotoxins – Lead, poly-biphenyls, etc 27 Prematurity TeachADHD/Singapore/2007 ADHD Is Not Usually Caused by: too much TV food allergies excess sugar food additives NOR BY parents or poor home life Teachers or poor schools TeachADHD/Singapore/2007 ADHD and sleep Sleep problems and ADHD: Students with ADHD complain or tiredness during day Often have difficulties falling asleep at night & waking up in the morning Poor / inadequate sleep impairs attention and performance in every one No clear evidence that sleep problems cause ADHD Stevens & Mulsow (2006) Pediatrics 117:665-72; Obel et al (2004) Pediatrics: 144: 1372-73 Bateman et al (2004) Arch Dis Child 89:506-11; Weiss et al (2006) JAACAP 45:512-9 TeachADHD/Singapore/2007
© Copyright 2024