ADHD 1 Flashcards
characteristics of ADHD - DSM-V
hyperactivity, impulsivity and attentional problems
DSM 5: ADHD – ‘A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development’
- often has difficulty sustaining attention in tasks or play activities (A)
- often fidgets with or taps hands or feet or squirms in seat (H/I)
several symptoms have to be present before age 12 and manifest in more than one context
3 presentations of ADHD in DSM-V
predominantly inattentive
predominantly hyperactive-impulsive
combined
ICD-11
ADHD (2010) - ‘a persistent pattern of inattention and/or hyperactivity-impulsivity that has a direct negative impact on …. functioning’
very similar to the DSM definition - came later than it
prevalence of ADHD in UK - gender difference
5% of children/adolescents in UK
3 : 1 , boys : girls
presents differently in boys (hyperactive) and girls (inattentive)
change in ADHD symptoms with age
symptoms continue into adulthood in 8-43% of cases (gender gap may narrow with age)
some think it can develop in adulthood, not just childhood
activity issues decline with age (hyperactive)
attentional issues remain (inattentive)
maybe gender imbalance in children due to how it is diagnosed
treatments for ADHD
in children over 5, adolescents, and adults:
drug treatment - Adderall (DL-amphetamine) or methylphenidate
these are drugs of abuse (class B) - but are prescribed to children as young as 6
very effective medications - but need non-addictive instead as this could be an issue
estimated medical and non-medical cost of ADHD + reasons why
£2.4billion (children and adolescents in UK)
due to:
- parental income loss
- juvenile detention
- medication costs
- schooling etc.
history of ADHD full timeline (9)
1902 - George Frederic Still - paediatrician described 20 cases of children
1917-28 - encephalitis lethargica epidemic - associated symptoms of ADHD with brain damage - called it postencephalitic-type behaviour disorder
1940/50s - minimal brain damage as a cause of postencephalitic-type behaviour disorder
1960s - minimal brain dysfunction (MBD) - hyperkinetic impulse disorder could occur without brain damage - changed label to dysfunction
1968 - DSM-II : hyperkinetic reaction of childhood - label of MBD as too broad so focus on specific symptoms (esp hyperactivity)
1980 - DSM III - “Attention Deficit Disorder (ADD) (with or without hyper-activity)” - three separate symptom lists for inattention, impulsivity, and hyperactivity - big jump from saying hyperactivity was essential for the disorder previously
1987 - DSM III-R “Attention Deficit Hyperactivity Disorder” - first time having ADHD written in a diagnostic manual, brough the symptom lists together
1994 - DSM - IV - first time ADHD was said to be able to be present in adults as well as children
2013 - DSM - V - very similar to the 1994 definition
history of ADHD - first description
1902 - George Fredric Still
- paediatrician
- described 20 cases of children with: “defect of moral control…. without general impairment of intellect and without physical disease”
- “the immediate gratification of self without regard either to the good of others or to the larger and more remote good of self”
- “fidgety….”
- “a quite abnormal incapacity for sustained attention”
what we now think of as ADHD
“moral control” meaning not considering others as much, not right and wrong
history of ADHD - 1917-1928
epidemic of encephalitis lethargica (brain swelling)
had levels of severity
bad cases = can become rigid - eye muscles become paralysed so the eyes roll and stay open and upwards
many died
many affected children who survived the encephalitis, subsequently showed abnormal behaviour
“Postencephalitic behaviour disorder”:
- children often became: hyperactive, distractible, irritable, antisocial, destructive, unruly, and unmanageable in school
first association with brain damage
because encephalitis = brain swelling –> idea that similar symptoms seen in ADHD may also be associated with brain damage
history of ADHD - 1940s/50s
minimal brain damage
assumption that minimal damage to the brain, even when it cannot be demonstrated objectively, causes postencephalitic-type behaviour disorder
became practice to infer brain damage from behaviour even when there’s no evidence of it - bad practice
history of ADHD - 1960s
Minimal brain dysfunction (MBD)
Became clear that this disorder (“hyperkinetic impulse disorder”) could occur in the absence of explicit brain damage
The Oxford International Study Group of Child Neurology therefore advocated a shift in terminology by replacing the term “minimal brain damage” by “minimal brain dysfunction”
history of ADHD - 1968
change from a broad label (MBD) to more focused in on specific symptoms - especially hyperactivity
DSM-II : hyperkinetic reaction of childhood
(DSM-I had no section about children in it)
history of ADHD - 1980
throughout 70s, developing realisation that attentional problems were as significant, or more significant, than hyperactivity in this patient group
1980 - DSM III - “Attention Deficit Disorder (ADD) (with or without hyper-activity)”
hyperactivity was no longer an essential diagnostic criterion for the disorder
developed three separate symptom lists for:
- inattention
- impulsivity
- hyperactivity
history of ADHD - 1987
DSM III-R “Attention Deficit Hyperactivity Disorder”
brought symptom list together
merge things together into one disorder