MARI A T RAPP, PH.D. De pa rtme nt o f Psyc hia try & Be ha - - PowerPoint PPT Presentation

MARI A T RAPP, PH.D.

De pa rtme nt o f Psyc hia try & Be ha vio r Sc ie nc e Unive rsity o f Okla ho ma

ADUL T ADHD: DI AGNOSI S & T RE AT ME NT

Ma ria T ra p p , Ph.D.

De finitio n:

Atte ntion De fic it Hype ra c tivity Disorde r is de fine d a s a c o mmo n ne uro psyc hia tric diso rde r tha t is a lo ng te rm c o nditio n tha t b e g ins in c hildho o d & c o ntinue s thro ug ho ut the pa tie nt’ s life time .

Ac c o rding to the NI MH

1, the L

ife time Pre va le nc e Ra te sta nds a t 8.1%, with ma le s ha ving a hig he r pre va le nc e ra te tha n fe ma le s2

Clinic a l Crite ria :

• E

xe c utive F unc tio ning de fic its

• I

na tte ntio n

• I

mpulsivity

• Re stle ssne ss
• E

mo tio na l Dysre g ula tio n

• Othe r impa irme nts inc luding he a lth a nd so c ia l issue s

ST UDI E S SUGGE ST T WO SYNDROME S:

Childho o d Onse t & Adult (L a te ) Onse t

Pr e dic tor s fr

• m Childhood

ADHD to Adult Symptoms:

• Se ve r

ity of Symptoms as a Child

• Comor

biditie s 3,4

• Par

e ntal Me ntal He alth Pr

• ble ms

3, 4

No n-I nflue ntia l F a c to rs:

• SE

S

• Pa re nt E

duc a tio n

• Pa re nt-Child Re la tio nship

DI AGNOSI S:

(Ac c o rding to DSM-5)5

• A. A pe rsiste nt pa tte rn o f ina tte ntio n a nd/ o r hype ra c tivity tha t

inte rfe re s with func tio ning o r de ve lo pme nt, a s c ha ra c te rize d b y five o r mo re sympto ms tha t ha ve pe rsiste d fo r a t le a st 6 mo nths fro m c a te g o ry 1 – I na tte ntio n o r c a te g o ry 2 – Hype ra c tivity o r b o th (c o mb ine d):

• 1. I

na tte ntio n

• F

a ils to g ive c lo se a tte ntio n to de ta ils o r ma ke s c a re le ss mista ke s

• Ha s diffic ulty susta ining a tte ntio n to de ta ils

DI AGNOSI S:

(Ac c o rding to DSM-5)5

• Do e s no t se e m to liste n whe n spo ke n to
• Do e s no t fo llo w thro ug h o n instruc tio ns
• Ha s diffic ulty o rg a nizing ta sks o r a c tivitie s
• Avo ids, dislike s o r is re luc ta nt to e ng a g e in ta sks tha t

re q uire susta ine d me nta l e ffo rt

• L
• se s thing s ne c e ssa ry fo r ta sks o r a c tivitie s

DI AGNOSI S:

(Ac c o rding to DSM-5)5

• 2. Hype ra c tivy
• I

s e a sily distra c te d b y e xtra ne o us stimuli

• I

s fo rg e tful in da ily a c tivity

• Ofte n fidg e ts, ta ps ha nd o r fe e t, sq uirms in se a t
• Ofte n le a ve s se a t in situa tio ns whe re re ma ining se a te d

is e xpe c te d

• F

e e ling o f re stle ssne ss

DI AGNOSI S:

(Ac c o rding to DSM-5)5

• Una b le to e ng a g e in le isure a c tivitie s q uie tly
• Ac ting a s if “Drive n b y a Mo to r”
• Ofte n ta lks e xc e ssive ly
• I

nte rrupts during c o nve rsa tio n, c o mple te s pe o ple ’ s se nte nc e s

• Diffic ulty wa iting in line

DI AGNOSI S:

(Ac c o rding to DSM-5)5

B. Sympto ms we re pre se nt b e fo re a g e 12 C. Se ve ra l sympto ms a re pre se nt in 2 o r mo re se tting s D. Sympto ms inte rfe re with a nd/ o r diminish the pa tie nt’ s q ua lity

• f so c ia l, a c a de mic o r o c c upa tio na l func tio ning

E . Sympto ms a re no t b e tte r e xpla ine d b y a no the r me nta l he a lth diso rde r o r during the c o urse o f Sc hizo phre nia

• Combine d T

ype

• Pre domina ntly ina tte ntive pre se nta tion
• Pre domina ntly hype ra c tive / ina tte ntive

pre se nta tion

ASSE SSME NT :

• Clinic a l I

nte rvie w

• Adult Ne uro psyc ho lo g ic a l Histo ry Que stio nna ire
• Millio n Clinic a l Multia xia l I

nve nto ry – I V (MCMI

• I

V)

• We c hsle r Ab b re via te d Sc a le o f I

nte llig e nc e – Se c o nd E ditio n (WASI

• I

I )

• Co nne r’ s Co ntinuo us Pe rfo rma nc e T

e st I I (CPT I I V.5)

• Be c k De pre ssio n I

nve nto ry – 2 (BDI

• 2)
• Be c k Anxie ty I

nve nto ry (BAI )

• Bro wn Adult ADHD Sc a le s (Bro wn)
• Re pe a ta b le Ba tte ry fo r the Asse ssme nt o f Ne uro psyc ho lo g ic a l Sta tus (RBANS)
• T

ra ils Ma king pa rt A & B

• Co nne rs’ Adult ADHD Ra ting Sc a le s-Se lf-Re po rt: L
• ng Ve rsio n (CAARS-S:L

)

Be st Sc e na rio is a Multimo da l Appro a c h 7, 8

Me dic a tio ns i. Stimula nts ii. Othe r Me dic a tio ns Psyc ho lo g ic a l Co unse ling i. Co g nitive Be ha vio ra l ii. Mo tiva tio na l I nte rvie wing iii. Ma rtia l/ F a mily T he ra py L ife style Stra te g ie s Alte rna tive Me dic ine

Be st Sc e na rio is a Multimo da l Appro a c h 7, 8

Suppo rt Gro ups Pho ne Apps i. E ve rno te ii. Prio rity Ma trix iii. Re me mb e r the Milk On-L ine Suppo rt Gro ups i. We b md .c o m ii. CHADD.o rg iii. ADD.o rg

Re fe re nc e s:

1. T he Na tio na l I nstitute o f Me nta l He a lth: https:/ / www.nimh.nih.g o v/ he a lth/ sta tistic s/ a tte ntio n- de fic it-hype ra c tivity-diso rde r-a dhd.shtml# pa rt_154905 2. Bukste in, Osc a r: Atte ntio n de fic it hype ra c tivity diso rde r in a dults: E pide mio lo g y, pa tho g e ne sis, c linic a l fe a ture s, c o urse , a sse ssme nt, a nd dia g no sis. UpT

• Da te . 2019.

3. I nse rro , Alliso n. Gre a te r pre va le nc e o f ADHD fo und in a dults se e king me nta l he a lth se rvic e s. Pre se nte d a t Ame ric a n Pro fe ssio na l So c ie ty o f ADHD a nd re la te d Diso rde rs. Pub lishe d F e b rua ry 13, 2018. 4. Be lirg a n, S, E rso y, MA, E rso y, HT . Pre va le nc e o f a dult a tte ntio n de fic it hype ra c tivity diso rde r a nd c o mo rb id a xis-I diso rde rs a mo ng first time a pplie d c a se s o f a g e ne ra l psyc hia try o utpa tie nt c linic a nd a priva te psyc ho the ra py c e ntre . Psyc hiatry and c linic al Psyc ho pharmac o lo g y. 2018. 28 (1). 25-35. 5. Dia g no stic a nd sta tistic a l ma nua l o f me nta l he a lth diso rde rs. 5th e ditio n. 2013. Ame ric a n Psyc hia tric Asso c ia tio n. 6. E kinc i, S, Ozde l, K , Onc u, B, Co la k, B,K a nde mir, H. T e mpe rme nta l c ha ra c te risitic s in a dults with a tte ntio n-de fic it hype ra c tivity diso rde r: A c o mpa riso n with b ipo la r diso rde r a nd he a lthy c o ntro ls. Psyc hiatry I nve stig atio n. 2013. June . 10(2): 137-142. 7. Ma yo c linic : https:/ / www.ma yo c linic .o rg / dise a se s-c o nditio ns/ a dult-a dhd -dia g no sis. Ac c e sse d April 02, 2019. 8. Ge ffe n, G, F

• rste r, K

. T re a tme nt o f a dult ADHD: a c linic a l pe rspe c tive . T he rape utic Advanc e s in Psyc ho pharmac o lo g y. 2018 Ja nua ry; 8(1): 25-32.

QUE ST I ONS

MARI A T RAPP, PH.D.

De pa rtme nt o f Psyc hia try & Be ha vio r Sc ie nc e Unive rsity o f Okla ho ma