Lecture Notes: Understanding ADHD

Introduction

• ADHD (Attention Deficit Hyperactivity Disorder):
  • Neurodevelopmental disorder beginning in childhood.
  • Involves symptoms in two domains: inattention and hyperactivity.
  • Often noticed due to poor school performance or disruptive behavior.
• Controversy:
  • Risks of both underdiagnosis and overdiagnosis.
    • Underdiagnosis: Can lead to severe life impairments (low academic performance, unstable relationships).
    • Overdiagnosis: May stigmatize children, foster dependence on medication, or overlook environmental issues.

Core Symptom Domains

Inattention

• Difficulties in maintaining focus.
• Symptoms: Captured in the mnemonic "DETAILS OFF".
  • Disorganized, Easily distracted, Task avoidance, Appears to ignore instructions, Incomplete tasks, Loses things, Sloppy work.
• People with ADHD might focus well on subjects of interest.

Hyperactivity

• High energy levels leading to impulsivity.
• Symptoms: Captured in the mnemonic "HE RILED UP".
  • Hyperactive, Energetic, Runs around, Interrupts or intrudes, Loud, Effusive, Difficulty waiting, Unseated, Premature answers.

Diagnosis Challenges and Mnemonics

• ADHD does not require both inattention and hyperactivity.
• FIDGETY Mnemonic:
  • Functionally impairing impulsivity/distractibility.
  • Inattention greater than expected.
  • Diagnosed by exclusion, Evidence across settings.
  • Timing of onset before age 12.
  • Young age onset.
• Diagnosis of exclusion: Other causes must be ruled out.

Incidence and Demographics

• Affects ~10% of children, 5% of adults.
• Most common is inattentive subtype.
• High heritability (~75%), environmental factors also play a role.
• Onset typically between ages 3-8, more common in males (2:1 ratio).
• Chronic and enduring symptoms.

Impacts and Treatment

Impacts

• Educational, relational, and psychiatric challenges in children.
• In adults: linked to academic, job, and personal challenges.

Treatments

• Behavioral Therapy:
  • Includes CBT and family therapy.
  • Medium effect size (0.6 - 0.7).
• Medications:
  • Stimulants: Methylphenidate (Ritalin) and Amphetamine salts (Adderall).
    • High effect size (> 1.0), but risks include growth restriction, appetite suppression, insomnia.
  • Non-stimulants: Atomoxetine, Guanfacine, Clonidine.
    • Lower effect size (~0.5), used when stimulants are unsuitable.

Summary

• ADHD requires careful screening and diagnosis.
• Effective treatments can lead to significant improvements in functioning.
• Important to consider potential downsides of diagnosis and rule out other factors.

Conclusion

• Gratifying to work with individuals with ADHD due to potential for dramatic improvements.
• Further reading: "Memorable Psychiatry" book recommended.

These notes summarize key points on ADHD, diagnosis challenges, impacts, and treatment options.