CLINICAL PICTURE Course of the Disorder Psychosocial Impairments

CLINICAL PICTURE Course of the Disorder – Psychosocial Impairments Functional Impairments Symptom domains Inattention Hyperactivity Impulsivity + SELF – low self esteem accidents substance abuse delinquency Lead to Psychiatric Co-morbidities Conduct disorder Oppositional Defiant Disorder Anxiety and Mood Disorders Zuddas, ADHD in Europe, 2004 SCHOOL- academic difficulties underachievement HOME- Family stress Parenting difficulties SOCIAL- Poor peer relation ships

Low self esteem, poor social skills , challenging behavior Substance abuse UNMANAGED ADHD leads to COMPLICATIONS School Extension Mood disorder ADHD only Age Disruptive behavior Conduct disorder ODD LD 6 Complex LD 10 14 -16 Adapted from American Psychiatric Association m DSM IV TR 2000

ADHD : Treatment Goals l l l Decrease disruptive/setting –inappropriate behaviors Improve relationship with parents, siblings, teachers or peers Improve academic performance Improve self esteem Improve organizational skills and overall executive functioning American Academy of Child and Adolescent Psychiatry, 2004

ADHD: Treatment Options l Educational Accomodations l l Behavior Therapy l l Classroom placement, special education, tutoring, private schools Parent training, social skills training, behavior modification, daily report card Medications l Stimulants, nonstimulants, tricyclic antidepressants

FDA-Approved Pharmacotherapy Stimulant Medications l Methylphenidate l l l l Ritalin ® Concerta ® Ritalin LA ® Methylin ® Focalin ® Metadate CD Amphetamine Mixed Salts l l Adderall ® Aderall XR ® Not available in drugstores

Prognosis of ADHD l l Symptoms of ADHD persist throughout childhood 70% continue to have the disorder in adolescence, with 10 -60% to adulthood More likely to persist in those with aggression or conduct problems Untreated adults have increased incidence of aggressive behavior, antisocial and conduct disorder, divorce, alcohol and drug abuse

Life Expectancy l l Adults with ADHD may achieve lower socioeconomic status and have more marital problems than do the general population They have the same life expectancy

Developmental Disabilities Down Syndrome Autistic Spectrum Disorders Learning Disabilities Birth---Infancy-----Early Childhood----School Age ---Adolescence Cerebral palsy ADHD