Attention Deficit/Hyperactive

Disorder
(ADHD)

Angie Andrews
Fred Lusk

1
History

2
Before 1900s

3
 Before 1900s
As long as there have been humans, there has
probably been ADHD.

They were often seen as being unruly,

unteachable, wicked or even possessed.

(Julkowski, Sharp, Stoleenbery, 1997, p. 14) 4

1902

5
 1902
• Sir George Frederick Still, an early researcher,
argued there was a “deficit in moral control”
and that aggressive and defiant behavior,
resistance to discipline and impaired attention
were all symptoms of a lack of moral
attributes.

(Julkowski, Sharp, Stoleenbery, 1997, p. 14-22)

6
1922

7
 1922
• Hohman called it “posetenephaltic behavior”
after the influenza pandemic that swept the
world and he theorized that the infection
affected certain parts of the brain that left
behavior changes afterwards

(Julkowski, Sharp, Stoleenbery, 1997, p. 14-22) 8

1947

9
 1947
Strauss and Lentinen coined “Minimal Brain
Damage” and said the behavior was caused by
injury to the brain or maybe an inherited lack
of brain function.
Later in early 1960s, changed to Minimal Brain
Dysfunction, which minimized the role of brain
injury but still something was wrong with the
brain

(Julkowski, Sharp, Stoleenbery, 1997, p. 14-22) 10

1968

11
 1968
With DSM II
(Diagnostic and Statistical Manual of Mental
Disorders)
“Hyperkinetic Reaction of childhood” was
focused entirely on hyperactivity and only
included children

(Julkowski, Sharp, Stoleenbery, 1997, p. 14-22) 12

1980

13
 1980

DSM III: We finally have ADD

(Attention Deficit Disorder)

14
 1980- DSM III continued
There are three subcategories:
• ADDH – difficultly with attention and
hyperactivity
• ADD (with no H) – difficultly with attention but
without hyperactivity
• ADD-RT (Residual Type)- hyperactive when
younger, but hyperactivity faded. Still have
problems with attention

(Julkowski, Sharp, Stoleenbery, 1997, p. 14-22) 15

1994

16
 1994
Drum Roll Please……

DSM IV- FINNALY all types are labeled ADHD

No more ADD

17
 1994
Three types of ADHD:
Predominately Inattentive Type: Just problems
with attention
Predominately Hyperactive Type: Just problems
with hyperactivity
Combined type: Both attention and hyperactive
difficulties

18
(Wender, 2000, p. 255)
Symptoms and
Diagnosis

19
 Symptoms & Diagnosis
Okay, Turn over your handout

How many were marked YES?

These symptoms are the same ones from

DSM IV, where ADHD is coded 314

20
 Symptoms and Diagnosis
Dr. Wender, 2000, a professor and author, has a
great quote to keep in mind,
“What characterizes ADHD in children [and
adults] is the intensity, the persistence and the
patterning of the symptoms” (p. 9).
In other words, it isn’t enough to just have 6 of
each category but it has to form a significant
pattern

21
 ADHD and
Brain Chemistry

22
 ADHD and Brain Chemistry
Research is ongoing, but we now know:
• ADHD has definite roots in the central nervous
system (AKA the brain) (Hallowell and Ratey, 1994, p. 270)
• Dr. Judith Rapoport found most children have
slightly larger right front lobes versus left, but
those with ADHD had the same size. (Hartman, 1996, p. 156)
• In 1970, Kornesky postulated that a reduction in
norepinephrine and dopamine is to blame
(Hallowell and Ratey, 1994, p. 274)

23
 ADHD and Brain Chemistry
• Less neurotransmitters means less ability to
regulate attention and inhibitions, also might
explain why ADHD is hereditary (Wender, 2000, p. 36-37)
• Other studies have found the D2 Dopamine
receptor, which is linked to a hereditary gene,
has been shown to correlate with alcoholism
and other neuropsychiatric disorders. (Hallowell and
Ratey, 1994, p. 279)

24
 ADHD and Brain Chemistry
Norepinephrine Dopamine

25
 ADHD and Brain Chemistry
YOUR BRAIN ON SUGAR
• Zametkin, in 1990, used PET (positron emission
tomography) to measure radioactively dyed
glucose and see how the different areas
metabolized the glucose. He found that the
brains of those with ADD metabolized 8%
lower level of glucose and that the frontal
lobes were the areas with the most decrease
in activity (Hallowell and Ratey, 1994, p. 275)
26
 ADHD and Brain Chemistry
So why do we care?
Drs. Hallowell and Ratey, 1994, authors of Driven
to Distraction wrote,
“There is a difference between labeling
someone as unmotivated and labeling
someone as lacking the biological
predisposition to stay on task without
frequent reminders. (pg. 280)

27
Theoretical Causes

28
 Theoretical Causes
Heredity
CHADD (Children & Adults with ADHD), 2010,
explain “Although precise causes have not yet
been identified, there is little question that
heredity makes the largest contribution to the
expression of the disorder in the population”
(Causes, para. 1)

29
 Theoretical Causes
• Neurotransmitter Deficiencies (Dendy, 1995, p. 11)
• Thyroid Imbalances (Dendy, 1995, p. 11)
• Problems with Vision (Berne, 2002, p. 22)
• Premature Birth, C-Sections, other labor problems
(Berne, 2002, p. 25)

• Vaccines (Berne, 2002, p. 47)

• Heavy Metals or Pesticides (Berne, 2002, p. 47)
• Alcohol or tobacco use during pregnancy (Berne, 2002, p. 47)
• Injury to front lobes (Berne, 2002, p. 47)
30
 Theoretical Causes
Attack of Sugar, Again
“SUGAR IS POSION FOR AD/HD”
Zimmerman, 1999, author of the ADD Nutrition
Solution, p. 99
The brains of children with ADHD cannot
metabolize sugar as well and had a 50% lower
rise in Epinephrine and Norepinephrine in
response to high-glucose drinks in a lab study

31
Medications

32
 Methylphenidate
Brand Names: Ritalin, Metadate, Concerta
Type: Stimulant
How it works: Increases the release of dopamine
and norepinephrine
Serious Side Effects: fast, pounding, or uneven
heartbeats; feeling like passing out, fever,
aggression, restlessness, hallucinations, unusual
behavior, motor tics, easy bruising, dangerously
high blood pressure
http://www.drugs.com/mtm/methylphenidate.html
33
 Dextroamphetamine
Brand Names: Dexedrine
Type: Stimulant
How it works: Increases brain activity and the
ability to focus
Serious Side Effects: fast or pounding
heartbeats; fainting; dangerously high blood
pressure tremor, restlessness, hallucinations,
unusual behavior, or motor tics
http://www.drugs.com/mtm/dextroamphetamine.html
34
 Methamphetamine
Brand Names: Desoxyn
Type: Stimulant
How it works: Increases brain activity and focus
Serious Side Effects: fast, pounding, or uneven
heartbeats, fainting, dangerously high blood
pressure, tremor, restlessness, hallucinations,
unusual behavior, or motor tics

http://www.drugs.com/mtm/methamphetamine.html
35
 Mixed Amphetamine Salts
Brand Names: Adderall
Type: Stimulant
How it works: Adderall is a mix of half
Dextroamphetamine and half amphetamine, to
increase effectiveness and avoid drug tolerance
Serious Side Effects: fast, pounding, or uneven
heartbeats, fainting, increased blood pressure,
tremor, restlessness, hallucinations, unusual
behavior, or motor tics
http://www.drugs.com/mtm/Adderall.html
36
 Lisdexamfetamine
Brand Names: Vyvanse
Type: Stimulant
How it works: Increases brain activity and ability to
focus, but designed to be harder to abuse than
Dexedrine because of a slow release and inability to
be taken intravenously
Serious Side Effects: fast, pounding, or uneven
heartbeats, decreased or dangerously high blood
pressure, tremor, restlessness, hallucinations, unusual
behavior, motor tics
http://www.drugs.com/mtm/lisdexamfetamine.html
37
 Risperidone
Brand Names: Risperdal
Type: Antipsychotic Drug
How it works: Creates a balance in
neurotransmitters in the brain, may calm some
hyperactivity, but only used for very severe cases
Serious Side Effects: fever, stiff muscles, confusion,
sweating, fast or uneven heartbeats; tremors,
white patches or sores inside mouth or lips,
trouble swallowing, fainting
http://www.drugs.com/mtm/risperidone.html
38
 Atomoxetine
Brand Names: Strattera
Type: Norepinephrine Reuptake Inhibitor (NRIs)
How it works: Enhances norepinephrine activity
Serious Side Effects: chest pain, shortness of
breath, fast or uneven heartbeats; fainting;
unusual behavior, aggression, hallucinations,
nausea, stomach pain, jaundice, increased
blood pressure, not urinating
http://www.drugs.com/mtm/atomoxetine.html
39
 Guanfacine
Brand Names: Intuniv
Type: Agonist (encourages natural processes)
How it works: Reduces blood flow and helps
relax and limit hyperactivity
Serious Side Effects: fast or slow heart rate;
pounding heartbeats, chest tightness;
numbness or tingling; or feeling like you might
pass out
http://www.drugs.com/mtm/guanfacine.html
40
Non-Medicinal
Treatments

41
 Non-Medicinal Treatments
The best treatments of ADHD are multimodal,
which means multiple interventions, medicinal
and non-medicinal treatments work together.
"Medications don't do everything. They turn the
volume down on symptoms, but they don't
teach people skills to manage their symptoms,“
–Stephen Safen, Clinical Psychologist

(CHADD, 2010, Treatment para. 1) and (Safen, 2010) 42

 Short-term or Long-term Counseling

(CHADD, 2010, Treatment, para. 4) 43

 Parent Training

(CHADD, 2010, Treatment, para. 2) 44

 Special Education/Occupation Therapy

(CHADD, 2010, Treatment, para. 3) 45

 Massage

(Personal Communication, Shane Stickle, 2010) 46

 Detoxing

(Berne, 2002, pg. 40) 47

 Herbal Remedies

(Zimmerman, 1999, p. 164)

48
 Homeotherapy

(Berne, 2002, p. 114)

49
 Aromatherapy

(Berne, 2002, pg. 119) 50

Auditory Integration Therapy (AIT)

(Berne, 2002, p. 113)

51
 Diet
Normal Recipe
Mac N’Cheese
½ lb semolina macaroni
2 tbls margarine
2 tbls unbleached flour
2 cups milk
1 tsp yellow mustard
1 cup cheddar cheese
1 tsp salt
1 tsp pepper
(Zimmerman, 1999, pg. 207)
ADHD Friendly Recipe
Mac N’Cheese
½ lb spelt, kamut or rice
macaroni
2 tbls homemade “sunshine”
butter or canola oil
2 tbls barley flour
2 cups plain soy milk
1 tsp yellow mustard
1 cup cheddar soy cheese
1 tsp sea salt
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Effects for Children
in Schools

53
 Academic Problems
• Underachievement is the “hallmark” of ADHD (Dendy,
1995, p. 357)

• Disorganization or loosing things (Dendy, 1995, p. 137)

• Difficultly planning ahead and lack of awareness of
time (Dendy, 1995, p. 138)
• Difficultly sustaining focus (Berne, 2002, p. 7)
“Since most children with ADD are not easily motivated
by consequences… as other children, it is very
difficult for them to have a natural love of learning.”
(Dendy, 1995, p. 357)

54
 Behavioral Problems
• Talks too much (Berne 2002, p. 8)
• Hot and explosive temper (Berne 2002, p. 8)
• Impulsive (Berne 2002, p. 8)
“Typically their behavior is not malicious but
rather the result of their inattention,
impulsivity, and failure to anticipate the
consequences of their actions” (Dendy 1995, p. 357)

55
 Help for Academics
• IEPs: Individualized Education Plans
• Special Education
IEPs and special education can help those with ADHD
by doing things such as providing notes to the
student from the teacher or an outline of the class
ahead of time, allowing for frequent breaks or ability
to get out of the seat, or very often different
“modalities of instruction,” allowing them to touch
and feel things, or whatever works best for the child.

(Personal Communication, Lessy Nixon, Head of Special Education for Campbel

County School System) 56
 Help with Behavior
FBAs (Functional Behavior Assessment)- evaluate
what things might lead to negative behavior,
how likely they are to occur and what the
consequences of that behavior
BIPs (Behavior Intervention Plan)- put in place
measures to avoid triggers to negative behavior,
create positive replacement behaviors and
rewards and inform school personal to be aware
of the situation and how to respond consistently

(PIC, 2008, para. 1) 57

 Help with Behavior
So is that a get of jail free card?

By law, a public school may suspend any student

for 10 days, but more than 10 days is
prohibited for any student with behavior
issues relating to an IEP

(PIC, 2008, para. 5)

58
 Help with Behavior

Lessy Nixon explained that in reality,

“It is more complicated, it’s not cut and dry.” It is
difficult to pin behavior directly to a disability and
that is interpreted very conservatively by the school
systems. If someone with ADHD acts out, while they
may be impulsive, if they normally show the ability
to plan and think things through their behavior, like
getting into fights, won’t be blamed on impulsivity.
But fidgeting in class might.
59
(Personal Correspondence, Lessy Nixon)
Effects for Adults

60
 Adults with ADHD
Adults w/ ADHD have difficulty getting
organized, getting up in the morning, and
being on time for work.

(NIMH, 2010) 61
 Diagnosing Adults
In order for an adult to be diagnosed with
ADHD, they must have a history of ADHD
symptoms from childhood to adulthood. The
therapist will interview the patient and their
family members. The content of the
interviews include childhood behaviors and
experiences. The patient will also undergo
psychological tests and a physical exam.

(NIHM, 2010) 62
 Things that can Help
“Using your cell phone is a good way to help
remind you of things.”
“Putting things on tape and playing it over and
over again is a way to remember things.”
-Debbie Biar, Counselor and Social Worker,
Personal Correspondence

63
 Counseling Adults
“A professional counselor or therapist can
help an adult with ADHD learn how to
organize his or her life with tools such as a
large calendar or date book, lists, reminder
notes, and by assigning a special place for
keys, bills, and paperwork. Large tasks can be
broken down into more manageable, smaller
steps so that completing each part of the task
provides a sense of accomplishment.”
(NIHM, 2010) 64
 Counseling Adults
“Psychotherapy, including cognitive behavioral
therapy, also can help change one's poor self-
image by examining the experiences that
produced it. The therapist encourages the
adult with ADHD to adjust to the life changes
that come with treatment, such as thinking
before acting, or resisting the urge to take
unnecessary risks.”

(NIHM, 2010)
65
Controversy

66
 Overdiagnosed?
According to the Center for Disease Control:
• As 2007,  Approximately 9.5% or 5.4 million
children 4-17 years of age have ever been
diagnosed with ADHD
• Boys (13.2%) were more likely than girls (5.6%)
to have ever been diagnosed with ADHD
• Diagnosis for AHDH have increased an average
of 5.5% each year from 2003 to 2006

(CDC, 2010, para. 2) 67

 Overdiagnosed?
According to Dr. Samuel Berne, 2002, author of
Without Ritalin, a controversial book:
• In 2002, $373 million was spent by consumers
on Ritalin and its generic counterparts
• Between 1997 and 2002, the production of
Ritalin increased by nearly 500%

(p. 5) 68
 Overdiagnosed?
YES
Dr. Berne argues, “children who attend school
are taking cocaine-derived Ritalin to alter their
minds and behavior, because the drug makes
them more a goal-oriented or task-directed.
But so what? Ritalin does nothing to improve
academic achievement or to improve learning
or reading.” (2006, p.13)

69
 Overdiagnosed?
Not Necessarily
Lessy Nixon, head of special education for
Campbell County Schools says,
“I don’t think it is necessarily over diagnosed, but I
do see families that have difficulty accepting it
and moving forward with it when medication is
needed…. If there is a child in the classroom
who has ADHD and who needs medicine, and it
is effective, there is a world of difference.”
(Personal Correspondence) 70
 Overdiagnosed?
Not always diagnosed enough
“Children with the inattentive component are
easier to miss, and more females have the
inattentive ADHD.”
(Personal Correspondence, Debbie Biar)

71
 Overdiagnosed?
Statically
CDC:
• 9.5% of children are diagnosed, where as the
DSMV IV states between 3% and 7% should be
diagnosed with ADHD
• But the DSMV IV is written by psychologists
and psychiatrists and there is no way to
magically know what % actually have ADHD

(2010, para. 2) 72
 Overdiagnosed?
Why might be Overdiagnosed?
• $$$ for drug companies
• $$$ for doctors in patients
• Parents: Quick fix for behavior problems
rather than real parenting
• Misdiagnosed (a child with a processing
difficultly might be mistaken for having ADHD)
• Higher Awareness
(Berne, 2002, pg. 5 and personal correspondence, Lessy Nixon) 73
 Advocacy
Many advocacy groups exist for those with ADHD,
which advocate treatment and understanding
CHADD (Children and Adults with ADHD) explains,
“AD/HD is a neurobiological disorder. It is characterized
by developmentally inappropriate impulsivity,
inattention, and in some cases, hyperactivity.
Although individuals with AD/HD can be very
successful in life, without appropriate identification
and treatment, AD/HD can have serious
consequences.” (Understanding, para. 2)
74
 Health Care
professionals with
ADHD

75
 A Massage Therapist/PTA student
Challenges:
Massage Therapy: “during a relaxation massage-
focusing on the client”
Student: “focusing on the instructor during lecture
time”
Overcoming:
“trigger point charts to study on the wall,” and “use
of technology helps... livescribe pen for taping
classes.”
(Shane Stickle, Personal Correspondence)
76
 PTA/Student for PT program

Challenges
PTA: “keeping up with documentation due dates
due to a change with contract companies,
documentation accuracy, working a set
schedule, communication with staff”
Student: “test taking, being attentive, being on
time for class”

77
 PTA/Student for PT program
Overcoming:
“print out… due list and highlight what is due from
me, created flow charts, set an alarm and make
myself get up on time and have recently started
laying out my clothing the night before and for class
have my stuff ready to go the night before as well”
“plan to have books ready for class and in van the
night before… accommodations for private testing,
and front row seat, and record lectures”

78
(Angie Andrews, Personal Correspondence)
 ER Nurse/PT Program
Challenges:
ER Nurse: “I have a hard time prioritizing what needs to be
done. Especially if we're busy.”
Student: “The hardest challenges are sitting through lectures.
And taking online classes.”
Overcoming:
“I've had to teach myself how to focus. I do arts and crafts type
things that require focus and attention… I try not to eat a lot
of processed sugars or things high in red dye.. I color code
my work/school schedule, and break the classes down into
different colors.”

(Chelsea Sawyers, Personal Correspondence) 79

 Guess Who?

Famous people with ADHD http://www.adhdtexas.com/famouspeople.htm 80

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Questions?

87
 References
• Bair, Debbie. (2010). Personal Correspondence November 18, 2010.
• Berne, S. (2002). Without Ritalin: A natural approach to ADD. Chicago, IL: Morris
Publishing
• CDC. (2010). Attention Deficit/Hyperactivity disorder (ADHD). Retrieved from
http://www.cdc.gov/ncbddd/adhd/data.html
• CHADD. (2010). Causes. Retrieved from
http://www.chadd.org/AM/Template.cfm?Section=Causes&Template=/CM/HTML
Display.cfm&ContentID=18052
• CHADD. (2010). Treatments. retrieved from
http://www.chadd.org/AM/Template.cfm?Section=Treatment&Template=/CM/HT
MLDisplay.cfm&ContentID=18040
• CHADD. (2010). Understanding. retrieved from
http://www.chadd.org/AM/Template.cfm?Section=Understanding
• Cherkes-Julkowski, M., Sharp S., and Stolzenberg J. (1997). Rethinking Attention
Deficit Disorders. Cambridge, Massachusetts: Brookline Books

88
 References
• Andrews, Angie (2010). Personal Correspondence on December 1, 2010.
• Dendy, C. (1995). Teenager with ADD: A parents’ guide. Bethesda, MD: Woodbine
House
• Drugs.com. (2010). Drug Information Online. Retrieved at http://www.drugs.com/
• Hallowell, E. MD and Ratey, J. MD (1994). Driven to Distraction. New York, New
York: Pantheon Books
• Hartmann, T. (1996). Beyond ADD: Hunting for Reasons in the past and present.
Grass Valley, California: Underwood Books
• NIHM (2010). Can adults have ADHD? Retrieved at
www.nimh.nih.gov/.../publications/attention-deficit-hyperactivity-disorder/can-
adults-have-adhd.shtml - 21k
• Nixon, Lessie. (2010). Personal Correspondence on November 24,2010
• Parent Information Center on Special Education (PIC). (2008). My Child’s been
suspended and has an IEP, what are my rights? Retrieved at
http://www.nhspecialed.org/suspended.shtml

89
 References
• Saften, Steven A., Sprich, Susan., Mimiaga, Matthew., Surman, Craig., Knouse,
Laura., Groves, Meghan., Ottow, Matthew. (2010). Cognitive Behavior Therapy vs
Relaxation with Educational Support for Medication Treated Adults with ADHD and
Persistent Symptoms. Journal of American Medicine
• Sawyers, Chelsea. (2010). Personal Correspondence on November 26, 2010.
• Stickle, Shane. (2010). Personal Correspondence on December 1, 2010.
• Volkow, Nora D. (2009). Evaluating Dopamine Reward Pathway in ADHD: Clinical
Implications.
• Wender, P. M.D. (2000). ADHD: Attention-Deficit Hyperactivity Disorder in Children
and Adults. New York, New York: Oxford University Press
• Zimmerman, Marcia CN. (1999). The ADD Nutrition Solution. New York, New York:
Owl Books

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 Images
• Slide 3: From Monty Python and the Holy Grail
http://www.filmdetail.com/2010/10/05/monty-python-holy-grail-and-the-britis
h-censor/
• Slide 5: Picture of Barrow Shipyard Workers, 1900
http://www.sodahead.com/united-states/why-dont-the-obama-birth-
certificate-deniers-understand-they-are-getting-played/question-499895/?
link=ibaf&imgurl=http://www.southlakes.addr.com/userreq/BarrowShipYard
Workers1900.jpg
• Slide 7: From Mofia 2 Video game
http://www.techshout.com/gaming/2010/03/2k-games-mafia-ii-hits-ps3-xbox-
360-and-windows-pc/
• Slide 9: Martha Rountree in Meet the Press
http://www.gettyimages.ie/detail/50651533
• Slide 11: Hippie VW Bug
http://commons.wikimedia.org/wiki/File:Hippie_bug!_(1043753793).jpg 91
 Images
• Slide 13: The Empire Strikes Back Movie Poster
http://www.reelmovienews.com/movies/the-empire-strikes-back/
• Slide 15: The trail of OJ Simspon
http://people.howstuffworks.com/ten-controversial-court-cases1.htm 
• Slide 25:
Norepinephrine
http://www.rise.duke.edu/phr150/Performance/howitworks.html
• Dopamine
http://drugabuse.gov/pubs/teaching/teaching2/Teaching2.html
• Slide 43:
http://societyforhumanisticpsychology.blogspot.com/2009_10_01_archive.html
• Slide 44:
http://www.premierintegrity.com/programs_schools_forparents.html
• Slide 45:
http://library.furman.edu/resources/subject/edu/specialed.htm

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 Images
• Slide 46:
http://www.uc.edu/reccenter/programming/massage/default.html
• Slide 47:
http://corehq.com/feeling-thirsty
• Slide 48:
http://reviews.costco.com/2070/10030067/reviews.htm
• Slide 49:
http://www.alternativemed.ca/2009/09/25/healing-with-homeotherapy/
• Slide 50:
http://www.islandessence.com/aromatherapy.htm
• Slide 51:
http://www.auditoryintegration.net/AIT_about.html
• Slides 81 to 86: Google Images

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