Adult ADHD. 1. Overview of ADHD 4. Principles for managing ADHD. 2. Common features of ADHD in adults. 3. General approaches to managing ADHD

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1 Adult ADHD 1. Overview of ADHD 4. Principles for managing ADHD 2. Common features of ADHD in adults 3. General approaches to managing ADHD

2 Definition The name Overview of ADHD Definition Attention Deficit Neurodevelopmental Disorder Hyperactivity Disorder...is almost, but not quite, completely wrong

3 Definition The name... Attention Self-regulation Dysregulation Deficit Condition from birth... Neurodevelopmental Disorder Hyperactivity Restless & impulsive Disorder affecting the brain s......executive functions Part of the spectrum of normal...is almost, but not quite, completely wrong NB: ADD is old term for ADHD (they are the same thing)

4 Condition from birth... NOT parenting / environmental Mostly genetic in origin As heritable as height Multiple genes Function (neurochemistry) Condition from birth... affecting the brain s... Neurodevelopmental Disorder Environment plays a part Learning Epigenetics Structure ( wiring & networks)...executive functions

5 affecting the brain s... Function (neurochemistry) Dopamine Medscape Psychiatry says: Dopamine is "...involved in...brain regions that mediate emotion and sensitivity to rewards. This connection is related to interest that is highly integrated with attention. " Noradrenaline ( norepinephrine in USA) Wikipedia says: "...norepinephrine increases arousal and alertness, promotes vigilance, enhances formation and retrieval of memory, and focuses attention; it also increases restlessness and anxiety." Medscape Psychiatry says: [Norepinephrine] is considered to be a mediator of executive function including problem solving, priority setting, and selective attention" Networks linked to self-regulation Fewer connections Some brain regions are smaller Structure ( wiring & networks) Structure ( wiring & networks) Networks linked to self-regulation Fewer connections Some brain regions are smaller

6 Self-regulation...executive functions Self-regulation ADDMIN Time myopia / Time blind Short time horizon Time Goals Focus Filtering stimuli Emotions

7 ADDMIN Affect (Emotions) Directed attention (Focus) Affect (Emotions) Deliberate exertion (Effort) Memory (Working memory) Staying calm, smoothing emotions Emotional regulation (i.e. display of emotions) Frustration tolerance Initiating action (Activation) Noticing behaviour (Action)

8 Deliberate exertion (Effort) Directed attention (Focus) Sustaining focus Sustaining effort Switching focus Filtering information (focus on the right things) Thinking speed Time awarenes

9 Short term memory (holding things in mind) Memory (Working memory) Initiating action (Activation) Starting tasks Working memory (manipulating things in mind) Recall of long term memory Planning, organising, prioritising Estimating time

10 Monitoring and regulating self-behaviour Noticing behaviour (Action)

11 Adult ADHD Definition 1. Overview of ADHD 4. Principles for managing ADHD Neurodevelopmental Disorder 2. Common features of ADHD in adults 3. General approaches to managing ADHD

12 2. Common features of ADHD in adults The obvious The obvious Less obvious Common co-diagnoses Inattention Hyperactivity/Impulsiveness

13 Inattention Distractible Distractible Work not done to the standard capable Chronic procrastination Forgetful (buy groceries, work, bills, appointments, pick up the kids) Difficulty sustaining attention Can seem not to listen ( Spacey ) Poor organising Easily distracted

14 Work not done to the standard capable Incomplete Careless errors Vagues out Avoids perceived difficulty Force field Chronic procrastination Lacks detail

15 The obvious Poor organising Inattention Loses things Inefficient work practices Slow Distractible Work not done to the standard capable Chronic procrastination Poor organising Hyperactivity/Impulsiveness

16 Hyperactivity/Impulsiveness Restless Restless Fidgety Chatterbox Impatient/Impulsive Moves about Difficulty settling

17 Chatterbox Impatient/Impulsive Loud Excessive talking Struggles to wait Interrupts Blurts out answers / talks over others

18 Interrupts Blurts out answers / talks over others Conversations Activities of others Others private space / personal items With family members With friends Can appear rude, selfish or attention seeking

19 2. Common features of ADHD in adults Less obvious The obvious Inattention Poor social skills / ostracised Hyperactivity/Impulsiveness Hypersensitive Less obvious Common co-diagnoses Moody

20 Hypersensitive Sound Moody Touch Light Irritable (can appear to be oppositional) Excitable Stressed / Distressed Emotions

21 Common co-diagnoses 2. Common features of ADHD in adults The obvious Behavioural Chronic / Developmental Less obvious Common co-diagnoses Acute / Episodic Learning Positives

22 Behavioural Chronic / Developmental Obsessive Compulsive Disorder Oppositional Defiant Disorder Conduct Disorder Physical injuries Autism Spectrum Disorder Motor / Vocal Tics Bipolar Disorder Developmental Coordination Disorder (DCD)

23 Acute / Episodic Learning Depression Anxious Dyslexia & other reading disorders Dyscalculia Dysgraphia Learning Speech

24 Positives Creative Sensitive to others Independent Can be good in a crisis 2. Common features of ADHD in adults The obvious Less obvious Common co-diagnoses Can be exceptionally talented...

25 Adult ADHD Definition 1. Overview of ADHD 4. Principles for managing ADHD Neurodevelopmental Disorder 2. Common features of ADHD in adults The obvious Less obvious 3. General approaches to managing ADHD Common co-diagnoses

26 Increase Dopamine 3. General approaches to managing ADHD Increase Dopamine Interest/Reward Manage lack of Dopamine Address ADHD s companions Urgency/Threat Medication

27 Medication Medication Stimulants Methylphenidate (Ritalin) group Short acting (Ritalin) Stimulants Long acting (Concerta, Ritalin LR) Dexamphetamine group Short acting (Dexamphetamine) Non-stimulants Non-stimulants Long acting (Vyvanse) Atomoxetine (Strattera) Long acting Guanfacine (Intuniv)

28 3. General approaches to managing ADHD Increase Dopamine Manage lack of Dopamine Scaffold executive functions Manage lack of Dopamine Address ADHD s companions Performance Prompts Mood regulation skills

29 Self-beliefs Address ADHD s companions Lazy Co-diagnoses Stupid Self-beliefs Nurture strengths Incompetent Don t care Unlovable

30 Adult ADHD Definition 1. Overview of ADHD 4. Principles for managing ADHD Neurodevelopmental Disorder 2. Common features of ADHD in adults The obvious Less obvious Common co-diagnoses 3. General approaches to managing ADHD Increase Dopamine Manage lack of Dopamine Address ADHD s companions

31 4. Principles for managing ADHD Mind is smart, Brain is dumb Reduce friction Time does not exist Be you, be unique Plan for wrogn Mind is smart, Brain is dumb Mind is not brain Outsource your brain Important is not interesting Healthy life, healthy mind

32 Reduce friction Time does not exist Minimise decisions Create structure Beware of Now/Not-now (change the time horizon) Make the invisible visible

33 Be you, be unique Plan for wrogn Focus on what really matters Prompts, prods, & reminders Change the rules If it s not written down, it doesn t exist

34 Important is not interesting Healthy life, healthy mind Change the focus: What, How, Why, Who, Style Multitasking is a fairy story (minimise distractions) Sleep, diet, exercise & meditation (who knew?) Emotions matter

35 Adult ADHD Definition 1. Overview of ADHD 4. Principles for managing ADHD Mind is smart, Brain is dumb Neurodevelopmental Disorder 2. Common features of ADHD in adults Reduce friction The obvious Less obvious Common co-diagnoses 3. General approaches to managing ADHD Increase Dopamine Manage lack of Dopamine Address ADHD s companions Time does not exist Be you, be unique Plan for wrogn Important is not interesting Healthy life, healthy mind

DEAF CHILDREN WITH ADHD AND LEARNING DIFFICULTIES

DEAF CHILDREN WITH ADHD AND LEARNING DIFFICULTIES Scott R. Smith, MD, MPH Developmental-Behavioral Pediatrician University of Rochester Medical Center Common Complaints about Children with Problems Your