1. Diagnose Attention Deficit Hyperactivity Disorder (ADHD).

- Most common and studied psych disorder in children

- Axis 1 disorder in the DSM-IV multiaxial system
- Characteristics:
o Hyperactivity
o Perceptual motor impairment
o Emotional liability
o General coordination deficit
o Attention deficit (Duh!)
o Impulsivity
o Memory & thinking deficits
o Specific learning disabilities
o Speech & hearing deficits
o Equivocal neurological & EEG irregularities
o Sleep disorder
o Ado: X10 more likely to be depressed
o Stressful psychic events including disruption of family
equilibrium can contribute to ADHD
o 40-60% have impairment from symptoms into
adulthood
o It is associated with brain function disorders
Males 10: 1 Females
10% lower class, 5% middle
First-born males (more common)
Greater concordance in mono- than di-zygotic twins: 76%
Alcohol use disorder and antisocial personality disorder are more
common in parents of those with ADHD than in the general
population
Children with ADHD are at higher risk of developing CONDUCT
disorder
September is the peak month for ADHDs. WOW (Make sure you
pull out in January)
DDX
Criterion A:
(1) INATTENTION: 6 OR MORE of the following
have persisted for at least 6 months

OFTEN FAILS TO GIVE CLOSE ATTENTION TO DETAILS OR

MAKES CARELESS MISTAKES
OFTEN HAS DIFFICULTY SUSTAINING ATTENTION IN TASK
OR PLAY ACTIVITIES
OFTEN DOES NOT SEEM TO LISTEN WHEN SPOKE TO
DIRECTLY
OFTEN DOESNT FOLLOW THROUGH ON INSTRUCTIONS
OR COMPLETING TASKS.
OFTEN HAS DIFFICULTY ORGANIZING TASKS AND
ACTIVITIES
OFTEN AVOIDS OR DISLIKES TASKS REQUIRING
SUSTAINED MENTAL dEFFORT
OFTEN LOSES THINGS NECESSARY FOR TASKS OR
ACTIVITIES

(2) HYPERACTIVITY-IMPULSIVITY: 6 OR MORE of the

following have persisted for at least 6 months
HYPERACTIVITY:

EASILY DISTRACTED BY EXTRANEOUS STIMULI

OFTEN FORGETFUL IN DAILY ACTIVITIES

OFTEN FIDGETS WITH HANDS OR FEET OR SQUIRMS IN

SEAT
LEAVES SEAT WHEN REMAINING SEATED IS EXPECTED
RUNS ABOUT OR CLIMBS EXCESSIVELY WHEN
INAPPROPRIATE
DIFFICULTY PLAYING QUIETLY
OFTEN ON THE GO OR ACTS AS IF DRIVEN BY A
MOTOR
TALKS EXCESSIVELY

IMPULSIVITY:

BLURTS OUT ANSWERS BEFORE QUESTIONS HAVE BEEN

ASKED
DIFFICULTY AWAITING TURN
INTERRUPTS OR INTRUDES ON OTHERS

Criterion B. Some impairing symptoms presents before age

12!
Criterion C. Some impairment in 2 or more settings
(home/school)
Criterion D. Clear evidence that symptoms are reducing social,
academic and occupational functioning
Criterion E. Make sure symptoms are not caused by another
disorder!

2. Describe the Pathophysiology of ADHD

Remains unclear
NE & Dopamine are assoc.
ADHD kids = reduced brain volume reduc. In left prefrontal
cortex
Inattention may result from prefrontal and frontal lobe
dysfunction
Formally thought: dopamine transporters wer part of
pathophysiology but it not appears that the elevated
transporter density is due to the drugs we give against ADHD.
(Ex: methyphenidate and dextroamphetamine)
3. Discuss the treatment of ADHD.
1st! Pharmacotherapy: CNS stimulants
o Methylophenidate: dopamine reuptake inhibitor
o Dextroamphetamine (amphetamine): dopamine
releasing agent by reversing the flow of monoamine
transporter
Both above = dopamine agonist
o Dextroamphetamine + amphetamine salt combo =
ADDERALL
o Dexmethylphenidate: Focalin
Above drugs are stimulants its strange how they make the
ADHD pt. calmer: logic behind is that they stimulate the

prefrontal cortex in order to control behavior: reduce

hyperactive + improve attention!
Non-stimulants:
o Atomoxetine: selective norepinephrine reuptake
inhibitor (NRI)
o Guanfacine: Alpha 2 receptor agonist: sympatholytic
o Fish oil (omega-3) appears to reduce symptoms in some
children
Mild symptoms: 1st line = behavioral treatments
(preschoolers)
o Help with self-esteem