 ADHD

 Movie Review

Hamza Baloch

Submitted to: Ma’am Bushra

Department of Psychology

University of Karachi
 ADHD

Definition
A brain disorder that affects how you pay attention, sit still, and control your actions is attention
deficit hyperactivity disorder (ADHD). In kids and teenagers, it happens and can continue into
adulthood. The most frequently diagnosed psychiatric illness in children is ADHD. Boys are
more likely than girls to get it. It's usually seen during the early years of school, when a kid
appears to have trouble paying attention. You can't prevent or cure ADHD. But it can help a
child or adult with ADHD navigate their symptoms by spotting it early, plus getting a clear care
and education plan. An approximate 8.4 percent of children and 2.5 per cent of adults have
ADHD.1,2 ADHD is most only identified in school-aged children as it contributes to classroom
disturbance or school work difficulties. It can affect adults as well. It's more common to boys
than to girls.
(Figure 1)
The ADHD Levels. Adapted from the Kewley G (1999)

 ADHD in Children
Poor concentration, high levels of activity and impulsiveness are typical traits of normal
preschool children. As a consequence, a high degree of monitoring is the rule. And now, children
with ADHD will also stand out. In this age range, play speed and extreme motor restlessness are
often exceptionally low.8,9 Related problems, such as slow growth, Opposition behavior and low
social skills can also be present. If ADHD is a possibility, it is important to provide guidance and
support for targeted parenting. Particularly at this early level, parental tension may be immense if
the infant struggles to respond to ordinary parental demands and behavioral advice. Targeted

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work with pre-school children and their families has been found to be effective in improving
parent child engagement and reducing parental tension.
A primary school child with ADHD also starts to be seen as unusual as peers continue to
acquire the skills and maturity that allow them to learn independently in school. While a
responsive teacher may be able to change the classroom to allow a capable child with ADHD to
excel, the child is more likely to suffer academic disappointment, peer disappointment, and poor
self-esteem. Comorbid conditions, such as specific learning disabilities, can also have an effect
on the infant, further complicating diagnosis and treatment. Educational psychologists can help
to unravel the learning strengths and difficulties and provide guidance on the required support in
the classroom.
(Figure 2)
Emotional and family functioning in children with ADHD relative to controls. * Higher
scores suggest improved functioning. Questionnaire on Infant Welfare, CHQ

Frequently, problems at home or on trips with careers (for example, when shopping,
outdoors, or meeting other family members) often become more evident at this age. Parents will
notice that family members fail to take care of the child and that other children do not allow them
to party or play. Many of the children with ADHD have very poor sleep habits, and while they
do not seem to be There appears to be no need for a lot of sleep, and daytime activity is always
worse when sleep is seriously disrupted. As a result, parents have no time for themselves; they
have to watch them while the infant is awake.Not unexpectedly, family relationships can can be
extremely compromised and, in some situations, may break down, causing further social and
financial difficulties. This may lead children to feel unhappy or even sad.
In a study of mothers and fathers with 66 children, parents of children with ADHD mixed
and inattentive subtypes demonstrated greater frustration than parents with control children.17 In
comparison, ADHD in children has been reported to predict distress in mothers.18 Pelham et al

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reported deviant child habits that reflect significant persistent interpersonal stressors for parents
of ADHD.
A new research presenting sibling reports of ADHD described disturbance triggered by
signs and behavioral manifestations of ADHD as the most important problem. Siblings faced this
disruption in three main ways: victimization, treatment, and sadness and loss. Siblings described
being abused by the violent actions of their ADHD brothers because of the social and emotional
immaturity associated with ADHD. In comparison, as a result of the effects of ADHD and the
consequent disturbance, many of them. Little attention has been paid to the relationship between
siblings in families with ADHD children. Although it has been recorded that siblings of children
with ADHD are at higher risk for behavioral and emotional disorders,20 a more recent one Many
of the siblings described feeling nervous, concerned, and sad.
Broader social and family functioning has been measured using the Child Wellbeing
Questionnaire (CHQ), a parent rated health outcome test that evaluates physical and
psychosocial well-being.22–24 Studies have found that the treatment of ADHD with
atomoxetine, a new non-stimulant drug for ADHD, has resulted in better expectations of quality
of life, with changes in both social and fa. Further study to determine the ongoing quality of life
of children and their families following multimodal feedback is desperately needed.

 ADHD in young people

Adolescence can lead to a decrease in overactivity that is always so striking in younger

children, but inattention, impulsiveness, and inner restlessness remain major difficulties. A
skewed sense of self and a disturbance in normal self-development have been documented by
teenagers with ADHD.In addition, overly violent and antisocial behavior may occur, adding
more problems (fig 3). A research by Edwards et al27 analyzed adolescents with ADHD and
oppositional defiant disorder (ODD), which is characterized by the existence of distinctly
defiant, disobedient, provocative actions and the lack of more extreme dissocial or violent
behaviors that breach the law or the freedom of others, either. This teens classified themselves as
having more parent-teen tension than they did with group monitors. Increased parent-teen
friction was also recorded when parents of adolescents with ADHD completed a ranking
exercise. In comparison, a study of 11–15 year-olds found that people with hyperkinesis were
twice as likely to have "a severe lack of friendship" as the general population.
(Figure 3)
Antisocial behavior in teenagers with ADHD.26 The findings mostly reflect results in
adolescents with mental problems.

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  Symptoms
At one time or another, it is common for kids to have difficulty concentrating and acting.
Children with ADHD, however, do not simply develop out of these habits. The symptoms
persist, can be serious, and can cause problems at school, at home, or with friends.

 A kid with ADHD could:

 Daydream a significant amount
 A lot of forgetting or missing things
 Fidget or squirm
 Too much dialog
 Making reckless mistakes or making needless mistakes
 Having a tough time avoiding temptation
 Having problems taking turns
 Having trouble getting along with others
 Blurt out an answer before a question has been completed, finish other people’s
sentences, or speak without waiting for a turn in a conversation
 Have trouble waiting for his or her turn
 Interrupt or intrude on others, for example in conversations, games, or activities

Psychotherapy and Psychosocial Interventions

Several specific psychosocial interventions have been shown to help patients and their families
manage symptoms and improve everyday functioning. In addition, children and adults with
ADHD need guidance and understanding from their parents, families, and teachers to reach their
full potential and to succeed.

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For school-age children, frustration, blame, and anger may have built up within a family before a
child is diagnosed. Parents and children may need specialized help to overcome negative
feelings. Mental health professionals can educate parents about ADHD and how it affects a
family. They also will help the child and his or her parents develop new skills, attitudes, and
ways of relating to each other.

Behavioral therapy is a type of psychotherapy that aims to help a person change his or her
behavior. It might involve practical assistance, such as help organizing tasks or completing
schoolwork, or working through emotionally difficult events. Behavioral therapy also teaches a
person how to:

 monitor his or her own behavior

 give oneself praise or rewards for acting in a desired way, such as controlling anger or
thinking before acting

Parents, teachers, and family members also can give positive or negative feedback for certain
behaviors and help establish clear rules, chore lists, and other structured routines to help a person
control his or her behavior. Therapists may also teach children social skills, such as how to wait
their turn, share toys, ask for help, or respond to teasing. Learning to read facial expressions and
the tone of voice in others, and how to respond appropriately can also be part of social skills
training.

Cognitive behavioral therapy can also teach a person mindfulness techniques, or meditation.
A person learns how to be aware and accepting of one’s own thoughts and feelings to improve
focus and concentration. The therapist also encourages the person 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.

Family and marital therapy can help family members and spouses find better ways to handle
disruptive behaviors, to encourage behavior changes, and improve interactions with the patient.

Parenting skills training (behavioral parent management training) teaches parents the
skills they need to encourage and reward positive behaviors in their children. It helps parents
learn how to use a system of rewards and consequences to change a child’s behavior. Parents are
taught to give immediate and positive feedback for behaviors they want to encourage and ignore
or redirect behaviors that they want to discourage. They may also learn to structure situations in
ways that support desired behavior.

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Specific behavioral classroom management interventions have been shown to be
effective for managing youths’ symptoms and improving their functioning at school and with
peers. These research-informed strategies typically include teacher-implemented reward
programs that often utilize point systems and communication with parents via Daily Report
Cards.

Many schools offer special education services to children with ADHD who qualify. Educational
specialists help the child, parents, and teachers make changes to classroom and homework
assignments to help the child succeed. Public schools are required to offer these services for
qualified children, which may be free for families living within the school district. Learn more
about the Individuals with Disabilities Education Act

Stress management techniques can benefit parents of children with ADHD by increasing
their ability to deal with frustration so that they can respond calmly to their child’s behavior.

Support groups can help parents and families connect with others who have similar problems
and concerns. Groups often meet regularly to share frustrations and successes, to exchange
information about recommended specialists and strategies, and to talk with experts.

Pathophysiology And Genetics

ADHD has been conceptualized as a disorder affecting “frontal” circuitry due to associated
deficits in executive cognitive functioning. Structural imaging studies have documented diffuse
abnormalities in children and adults with ADHD. A large study by Castellanos and
colleagues 55 reported smaller total cerebrum, cerebellum, and the four cerebral lobes that did not
change over time. A structural magnetic resonance imaging (MRI) study 56 in adults with and
without ADHD also revealed a smaller anterior cingulate cortex (ACC) and dorsolateral
prefrontal cortex (DLPFC). The DLPFC controls working memory that involves the ability to
retain information while processing new information. These differences are thought to account
for deficits in goal-directed and on task behavior in ADHD. The ACC is thought to be a key
region of regulation involving the ability to focus on one task and choose between options.

Investigators have also examined the developmental pattern of cortical maturation in ADHD.
Shaw and colleagues 57 reported a delay in cortical thickness among ADHD patients. The pattern
of brain development, from sensorimotor to associative areas, was similar in children with and
without ADHD. However, the age of peak development was delayed in those with ADHD. Using
the same measure of cortical thickness data in adults, Makris and associates 58 have shown that
cortical thickness is not normalized and that the areas of the brain that are affected in children

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with ADHD remain affected in adulthood. In this study the DLPFC, parietal areas, and ACC had
thinner measures of cortical thickness in adults with ADHD than in adults without ADHD.

The neurobiology of ADHD is strongly influenced by genetic factors. As highlighted in a

special issue of Science dedicated to the human genome project, ADHD is among the most
recognized genetic-based disorders in psychiatry. Family studies of ADHD have shown that the
relatives of ADHD children are at high risk for ADHD, comorbid psychiatric disorders, school
failure, learning disability and impairments in intellectual functioning 63. Additional lines of
evidence from twin, adoption and segregation analysis studies suggest that the familial
aggregation of ADHD has a substantial genetic component. Twin studies find greater similarity
for ADHD and components of the syndrome between monozygotic twins compared with
dizygotic twins. Faraone and colleagues 66 in a meta-analysis of the various studies reported on
the mean heritability of ADHD. Heritability refers to the amount of genetic influence for a
particular condition. A coefficient of 1 indicates an entirely genetically influenced phenomenon,
while a 0 indicates no genetic influence. Depression, anxiety, panic, and even Asthma had mean
heritability rates below 50%. In contrast, two of the most biologically related psychiatric
disorders, schizophrenia and autism, are heritable at ~75%. ADHD falls in this higher range as
well, with work by Rietveld and associates showing a mean heritability rate of 75% 67. As with
many complex neuropsychiatric conditions, multifactorial causation is thought to be involved in
ADHD; an additive effect of multiple vulnerability genes interacting with environmental
influences. Pooled analyses reveal that there is not one single gene associated with ADHD 66.
The disorder is thought to result from a combination of small effects from a number of genes
(polygenetic). Some of the candidate genes that have been identified thus far relate to synthesis,
packaging, release, detection and recycling of dopamine or catecholamines including the post-
synaptic DRD4, dopamine transporter, and SNAP 25 genes; as well as others related to other
neurotransmitters such as serotonin. Clearly, more work is necessary in disentangling the
relationship of candidate genes in producing specific phenocopies of ADHD, as well as response
prediction to psychosocial and pharmacological intervention.

 Therapies
For certain patients, ADHD drugs alleviate hyperactivity and impulsivity and enhance their
ability to concentrate, function, and understand. Physical control can also be strengthened by
medicine. Often a variety of different drugs or dosages must be tested before finding the correct
one that fits for a single person. Every person taking drugs must be supervised closely and
carefully by their prescribed doctor.

 Treatment
In an attempt to find better ways to treat and minimize a person's chances of getting
ADHD, scientists are researching cause(s) and risk factors. The cause(s) and risk factors for
ADHD are unclear, but current research suggests that a significant role is played by genetics.
Recent twin studies have related genes with ADHD.11.

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 For most cases, ADHD is better treated with a mixture of behavioral therapy and medicine.
For pre-school children (4-5 years of age) with ADHD, behavioral therapy, particularly parents
training, is prescribed as the first line of treatment before the drug is attempted. What works best
will rely on your child and your relatives. Good recovery options will include close supervision,
follow-up and maki follow-up.
ADHD diagnosis requires a thorough review from a qualified clinician, such as a
pediatrician, physician or psychiatrist with ADHD experience. In order for a person to be
diagnosed with ADHD, signs of inattention and/or hyperactivity-impulsivity must be chronic or
long-lasting, hinder the functioning of the person and allow the person to lag behind the normal
growth of the person.

Scientists are researching other potential causes and risk factors, in addition to genetics,
including:

 Injury to the brain

 Environmental exposure (e.g., lead) during pregnancy or at a young age
 Usage of alcohol and tobacco during pregnancy
 Shipping prematurely
 Poor weight at birth

Study does not confirm the common view that ADHD is caused by eating too much food,
consuming too much tv, parenting, or social and environmental causes such as poverty or family
chaos. Of course, several factors, including these, could exacerbate symptoms, particularly in
some individuals. But the proof is not good enough to say that the key causes of ADHD are
these.

Attention-deficit/hyperactivity disorder is a heterogenous disorder that is prevalent worldwide

and frequently persists from adolescence into adult years. Attention-deficit/hyperactivity disorder
continues to be diagnosed by careful history with an understanding of the developmental
presentation of normal behavior and symptoms of the disorder. It has been reconceptualized as a
more chronic condition, with approximately half of children continuing to exhibit symptoms and
impairment into adulthood. Most individuals with ADHD have a comorbid disorder, including
oppositional, conduct, anxiety, or mood disorders. In addition, ADHD carries with it significant
impairment in academic, occupational, social, and intrapersonal domains necessitating treatment.
Converging data strongly support a neurobiological and genetic basis for ADHD, with
catecholaminergic dysfunction as a central finding.

Psychosocial interventions such as educational remediation, structure/routine, and cognitive

behavioral approaches should be considered in the management of ADHD. Contemporary work
exhibiting improved outcomes associated with specific cognitive therapies in adults with ADHD
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has been demonstrated. Extensive literature supports the effectiveness of pharmacotherapy not
only for the core behavioral symptoms of ADHD but also improvement in linked impairments.
Similarities between pediatric and adult groups in the presentation, characteristics, neurobiology,
and treatment response of ADHD support the continuity of the disorder across the lifespan.

References:

1. Alessandri SM. Attention, play, and social behaviour in ADHD preschoolers. J Abnorm
Child Psychol1992;20:289–302.

2. American Academy of Pediatrics, Reiff MI, Tippins S. ADHD—A Complete and

Authoritative Guide. Chicago: Independent Publishers Group, 2003.

3. Bagwell CL, Molina BS, Pelham WE, et al. ADHD and problems in peer relations:
Predictions from childhood to adolescence. J Am Acad Child Adolesc
Psychiatry2001;40:1285–92.

4. Barkley RA. Behavioral inhibition, sustained attention, and executive functions:

constructing a unifying theory of ADHD. Psychol Bull1997;121:65–94.

5. Barkley R. Psychosocial treatments for attention-deficit/hyperactivity disorder in

children. J Clin Psychiatry2002;63:36–43.

6. Barton J, Prasad S, Buitelaar JK, et al. 10-week, open-label, acute treatment with
atomoxetine in non-North American children with ADHD. Poster presented at the Royal
College of Psychiatrists Annual General Meeting. Edinburgh, UK, 30 June–3 July 2003.

7. Barkley RA. Attention deficit hyperactivity disorder: A handbook for diagnosis and
treatment, 2nd edition. New York: Guildford Press, 1998.

8. Cox DJ, Merkel RL, Penberthy JK, et al. Impact of methylphenidate delivery profiles on
driving performance of adolescents with attention-deficit/hyperactivity disorder: a pilot
study. J Am Acad Child Adolesc Psychiatry2004;43:269–75.

9. Cunningham CE, Benness BB, Siegel LS. Family functioning, time allocation, and
parental depression in the families of normal and ADHD children. J Clin Child
Psychol1988;17:169–77.

10. DuPaul GJ, McGoey KE, Eckert TL, et al. Preschool children with
attention-deficit/hyperactivity disorder: impairments in behavioural, social, and school
functioning. J Am Acad Child Adolesc Psychiatry2001;40:508–15.

11. DiScala C, Lescohier I, Barthel M, et al. Injuries to children with attention deficit
hyperactivity disorder. Pediatrics1998;102:1415–21.

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12. Edwards G, Barkley RA, Laneri M, et al. Parent–adolescent conflict in teenagers with
ADHD and ODD. J Abnormal Child Psychology2001;29:557–72.

13. Freeman RD, Fast DK, Burd L, et al. An international perspective on Tourette syndrome:
selected findings from 3,500 individuals in 22 countries. Dev Med Child
Neurol2000;42:436–47.

14. Faraone SV, Biederman J, Monuteaux MC, et al. A psychometric measure of learning
disability predicts educational failure four years later in boys with ADHD. J Atten
Disord2001;4:220–30.

15. Gillberg C, Gillberg IC, Rasmussen P, et al. Co-existing disorders in ADHD—

implications for diagnosis and intervention. Eur Child Adolesc Psychiatry2004;13 (Suppl
1) :I80–92.

16. Hankin CS. ADHD and its impact on the family. Drug Benefit Trends2001;13 (Suppl
C) :15–16.

17. Huss M, Lehmkuhl U. Methylphenidate and substance abuse: a review of pharmacology,

animal and clinical studies. J Atten Disord2002;6 (Suppl 1) :S65–71.

18. Kaidar I, Wiener J, Tannock R. The attributions of children with

attention-deficit/hyperactivity disorder for their problem behaviors. J Atten
Disord2003;6:99–109.

19. Mannuzza S, Klein RG, Bessler A, et al. Adult outcome of hyperactive boys. Educational
achievement, occupational rank and psychiatric status. Arch Gen Psychiatry1993;50:565–
76.

20. Pelham WE Jr, Lang AR. Can your children drive you to drink? Stress and parenting in
adults interacting with children with ADHD. Alcohol Res Health1999;23:292–8.

21. Sonuga-Barke EJ, Daley D, Thompson M, et al. Parent-based therapies for preschool
attention-deficit/hyperactivity disorder: a randomised, controlled trial with a community
sample. J Am Acad Child Adolesc Psychiatry2001;40:402–8.

22. Weiss M, Hechtman L, Weiss G. ADHD in Adulthood—A guide to current theory,

diagnosis and treatment. Baltimore: Johns Hopkins University Press, 1999.

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Movie Review

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 15 Park Avenue

The film is about shadows, shadows of failed relationships, shadows of psychosis, shadows
that borders between sanity and insanity. Konkona Sen Sharma is the daughter of Aparna and
Mukul Sharma. Mukul Sharma, a well known Indo English poet has instilled all the talents of
poetry in acting in her beautiful daughter Konkona. I saw Konkona in the seventies when she
was visiting the Kolkata zoo with her mother; her photographs were splashed all over Youth
Times. Konkona plays the role of disturbed Mithi. The movie tries to address quite a few things
in one go starting from the unique world of a disabled person to the unequal status of a female
even in today's modern India and also the twisted relationships in a tattered family. Jojo leaves
her and Mithi starts living in her own world of delusions, hallucinations and sometimes
convulsive fits. Schizophrenia is not a single disease item but rather a syndrome of psychological
symptoms which the patient believes are true. There is a point when nobody believes that Mithi
use to stay in 15 Park Avenue with her husband Jojo and their five children. She tells coolly the
exasperated sister that if I have to say that you are not a Professor and you are making it up all
the time, how you would feel. In the real world 15 Park Avenue doesn't exists as much as Jojo
and her five children. Yet many a time she hears voices talking to her, children's laughter and the
need to reach her home at 15 Park Avenue urgently. Some tantalizing experimental evidence
does exist that suggests that the stimulation of the brain by an external magnetic field can
rekindle old, dormant memories - and 'create' new hallucinations ("Temporal Lobe Epilepsy"). It
has been seen that people with TLE might be more prone to supernatural phenomena. There
might also be an element of chaos and 'non-reproducibility of results' involved here: if the reports
are anything to go by, phantoms should appear all over the place. Clearly this is not the case.
Perhaps they require certain environmental conditions to be (even approximately) met before
they appear. The effects of strong magnetic fields on the brain, causing transient Temporal Lobe
Epilepsy has been noted above: this can produce hallucinations and was trumpeted as an
"explanation" for ghosts. But the actual fields required are so large it is highly doubtful that they
could be produced naturally on the Earth. Temporal lobe Epilepsy has been widely seen to be
associated with Extra Sensory Perception, TLE remains a disease that can be controlled. The
patient's so called imaginary world must be taken seriously and confidence should be created to
let you enter that world. Mithi's world was real, she tried her best to let people believe and finally
when she stumbled on to her supposed home at 15 Park Avenue on an ancient house in Park
Street/Ballugunje corner, she found everything that she was looking for. She just went in and
disappeared. Only the Psychiatrist (Dhritiman Chatterjee) understood and was seen leading
everybody away from that house. A very old lady was seen to come out of the house. Aparna Sen
must have taken cue from James Hilton's Lost Horizon.

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