ADHD THROUGH THE MOVIES www adhdclinicjeeva com DR

ADHD THROUGH THE MOVIES www. adhdclinicjeeva. com DR SHABEER JEEVA CHILD AND ADULT PSYCHIATRIST LRCP, LRCS(IRELAND), D. PSYCH(OTTAWA), F. R. C. P(CANADA)

Patients with “ADHD” may suffer Because…. . • • Their parents don’t understand them; Their teachers can’t stand them; Their peers reject them; Their spouses and bosses can’t stand their disorganization and intensity; • They themselves begin to think: “no matter what I do I can’t win…”

Famous People with Attention Deficit and Learning Disorders • Albert Einstein • Nelson Rockefeller • Galileo • Thomas Edison • Sylvester Stallone • Mozart • Gen. George Patton • Cher • Leonardo da Vinci • John F. Kennedy • Gen. Westmoreland • Whoppi Goldberg • Bruce Jenner • Charles Schwab • Tom Cruise • Eddie Rickenbacker • Danny Glover • Henry Winkler • Harry Belafonte • John Lennon • F. Scott Fitzgerald • Walt Disney • Greg Louganis • Robin Williams • Steve Mc. Queen • Winston Churchill • Louis Pasteur • George C. Scott • Henry Ford • Werner von Braun • Tom Smothers • Robert Kennedy • Dwight D. Eisenhower • Suzanne Somers • George Bernard Shaw • Lindsay Wagner • Jules Verne • Beethoven • Alexander Graham Bell • “Magic Johnson” • Hans Christian Anderson • Woodrow Wilson • Carl Lewis

ADHD Diagnosis • 5 -9% children with this condition • 60% of these children go on to adulthood with impairing symptoms • Core symptoms are – Impulsivity – Attentional problems – Motor hyperactivity

Visual Images • Move in the academic teaching arena to use movies and visual processes as ways of teaching • ADHD patients respond better to visual systems rather than talking – Auditory processing problems – Strengths in visual-spatial ability – Ability to see the forest but not the trees

Impulsivity • An urge that is difficult to resist – Dennis the Menace – The Simpsons

Dennis the Menace

Inattention • Loss of order and loss of presence of mind – Home Alone – Inspector Gadget – Gilligan’s Island – Get Smart

Home Alone 2

Motor Hyperactivity • Any movie by – Jim Carrey – Robin Williams – Howie Mandell – Tom Cruise

ADHD-Developmental • You must accept that if ADHD is a lifelong disorder, then your personality must change. The Adult is still having power battles with authority figures which is similar to the power battles within themselves. • Different Examples -Officer and a Gentleman -Goodwill Hunting -The Lion King -Mrs. Doubtfire

ATTENTION DEFICIT DISORDER A. D. IMPULSIVITY Failure to think of Consequences before acting ATTENTION = DISTRACTIBILITY Trouble holding focus ------------------------------------------------- A. D. H. D. “Combined” + OVERACTIVITY

Symptoms of Hyperactivity Often Manifest Differently in Adults Hyperactivity often changes to inner restlessness DSM-IV Symptom Domain Common Adult Manifestation • Squirms and fidgets • Workaholic • Can’t stay seated • Overscheduled/overwhelm • Runs/climbs excessively • Can’t play/work quietly • “On the go”/driven by motor ed • Self-selects a very active job • Constant activity leading to

Symptoms of Inattention Often Manifest Differently in Adults DSM-IV Symptom Domain § Difficulty sustaining attention § Doesn’t listen § No follow-through § Can’t organize § Loses important things § Easily distractible, forgetful Common Adult Manifestation § Difficulty sustaining attention − Meetings, reading, paperwork § § Paralyzing procrastination Slow, inefficient Poor time management Disorganized

Symptoms of Impulsivity Often Manifest Differently in Adults Impulsivity in adulthood often carries more serious consequences DSM-IV Symptom Domain § Blurts out answers § Can’t wait turn § Intrudes/interrupts others Common Adult Manifestation § Low frustration tolerance − Losing temper − Quitting jobs − Ending relationships − Driving too fast − Addictive personality

ADHD Impairment Persists Childhood School failure or underachievement Becomes Multiple injuries Becomes Drug experimentation Becomes Oppositional defiant or conduct disorder Becomes Impulsivity, carelessness Becomes Repetitive failure Becomes Adulthood Job failure or underemployment Fatal car wrecks or risk taking Drug dependence Antisocial personality disorder, criminality Unwanted pregnancy, sexually transmitted disease, etc Hopelessness, frustration, giving up Courtesy of W. Dodson, MD

Diagnosis of ADHD in Adults: Common Clinical Histories • Difficulties in Elementary or Secondary School – Comments: “not living up to potential, ” “spacey, ” “hyper” – Behavioral issues: “class clown” • Difficulties in College – Incomplete degree or longer time to complete degree – Difficulty engaging in further education • Difficulties at Work – Underachievement (mixed reviews) – Low efficiency: 4 times longer to complete tasks • Difficulties at Home – Poor organization, does not complete tasks – Strained relationships with spouse and kids (who also may have ADHD) Courtesy of T. Wilens, MD

Sound of Music

Office Presentation Patients with ADULT ADHD: • • Are forgetful or “airheads” Miss appointments or arrive late Lose prescriptions Do not carry out instructions or the treatment plan • Are hypertalkative • Are “passionate” or have emotional storms triggered by events

ADHD and Comorbid Conditions Inattention Impulsivity/ Hyperactivity Comorbidity

Clinical Presentation • Multiple mental health consultations • Multiple jobs • Stormy relationships • Trouble with authority figures; arrest record • Family history of bipolar disorder, substance abuse, or Tourette syndrome • Family history of ADHD • Performance and mood determined by interest and challenge

Comorbid Psychiatric Disturbances Are Common in Adults With ADHD Antisocial Disorder (10%) Major Depressive Disorder (35%) Bipolar Disorder (15%) Anxiety Disorders (40%) Substance Abuse Disorders (50%) Shekim WO et al. Compr Psychiatry. 1990; 31: 416 -425. Biederman J et al. Am J Psychiatry. 1993; 150: 1792 -1798.

Officer and A Gentlemen

ADHD Comorbidity in Adults with Other Psychiatric Disorders Disorder ADHD Rate Major Depression 1 20% Bipolar Disorder 2 15% Generalized Anxiety Disorders 3 20% Substance Abuse 4 25% Re-evaluate refractory patients for ADHD 1. Alpert et al. Psychiatry Res. 1996. 2. Nierenberg et al. APA Presentation. 2002. 3. Fones et al. , J Affective Dis; 2000 4. Wilens. Psych Clin N Am; 2003.

Domains of Impairment Health/Injury Academic/ Occupational Self-esteem Substance Abuse Impairments Sexual Behavior Social Functioning Criminality

Mrs. Doubtfire

ADHD Owners Manual Many people with ADHD don’t realize they have an owner's manual. We help them to learn about themselves. This is the way you are. ---How to maximize your strengths and minimize your weaknesses. It helps people look at themselves in a more positive way and to learn why things have happened.

Potential Areas of Impairment Ch ildr Academic limitations Relationships Adults Occupational/ vocational Low self esteem ADHD Legal difficulties en Motor vehicle accidents Injuries Smoking and substance abuse Adolescents

Sound of Music

Pharmacotherapy in Adults • Stimulants – – • • Methylphenidate-Ritalin Amphetamine compounds-Dexedrine Magnesium pemoline (not recommended) Long acting stimulants -Ritalin-SR. Ritalin-L. A, Concerta, Adderal XR Atomoxetine (FDA-approved in adults)-Straterra Antidepressants – Bupropion-Welbutrin SR – SSRI/SNRI – Tricyclics • Other - Mood Stabilizers: Valproic Acid/Lithium - Atypical Antipsychotics: Resperidone - Clonidine Research – Modafinil

ADHD, ODD and CD Integrative Interventions • Preventative interventions (i. e. preventing the development of comorbid disorders) • Patient, parent, spouse training and support • Individual counseling and therapy • Group counseling and therapy • Family counseling and therapy • Interventions at school and work place • Medication eg. Resperidone • Working with correctional systems Turgay (2001), The World of Children # 4, Winter 2001 pp: 9 -28

Lion King

Conclusions • ADHD symptoms are impairing • The symptoms continue into adulthood • Early problems of attachment lead to a false sense of self • Insight to the clinical symptoms has profound implication to treatment and compliance

? ADULT ADHD SYMPTOMS