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now what is it that is delayed two traits
the first is not the one after which the disorder is named
and in that
sense the disorder has been misnamed the first deficit to appear
is inhibition a failure to develop an
appropriate inhibition of your behavior and this what
often emerge in the preschool years and its first sign is usually hyperactivity
though it doesn't need to be so but it typically is you have an individual who
is behaving
too much who is not suppressing irrelevant behavior
the way other children are able to do we will see this
in their motor actions there's a lot of action coming out of this child
we will see it in their verbal behavior there's a lot of words coming out of this
individual
and we will see it in their intrusive
and disruptive motor and verbal behavior as well but along with that
there is a cognitive impulsiveness this
snap decision making this quickness to do the first thing that pops into your head
without due delay and due diligence
thinking about what the consequences will be
and then we will also see
the restlessness not just the gross motor activity but the seat restlessness
which I think affects their school performance more than
the gross motor activity does but this will decline with age so that is why
hyperactivity is no longer the name of this disorder
because it declined steeply and by adolescence it is nearly gone
and by adulthood it is an internal state it is a feeling
inwardly of an need to be busy and doing multiple things
and its a busyness of one's mind
ones ideas there is a restless quality to their cognition
but not to their outward behavior in fact our research has shown that
hyperactivity is have no diagnostic value
in adulthood in fact being restless is more associated with anxiety disorders
by the time you are
30 then it is being associated with ADHD we just don't pay attention to it
it is of no relevance to diagnosis so
let's understand that the real problem here is not restlessness
it is in fact inhibition their is
a failure to develop appropriate inhibition and it affects your behavior it
affects your words
it affects your mind and your thoughts and we need to return to the idea which
we have gotten rid of
that it affects your emotions for the first hundred and seventy years of the
history
of ADHD in the medical literature which began in 1798
not 1902, eight years ago
the last remaining copy of a medical textbook
was discovered at Kent State University this text book was written by the
Scottish physician
then living in colonial America Alexander Crichton
and Crichton had written a medical textbook in which their is
a chapter entitled diseases of attention and it
is the first description of this disorder and it's very good by the way
so ADHD did not begin in 1902
it started in 1798 as far as the first initial
medical reference and from that point on until 1976
emotion was part
I've ADHD every major theorist
every paper every science paper including that of Mark Stewart
when the first major scientific descriptions
the Canadian papers by Whitson heckman and wary
and Douglas and others back in the sixties and seventies
all included emotional impulsiveness
as part of this disorder but the DSM
parse to decide and made it and associated problem in some people
it isn't it is as much a core feature of this disorder as is any other symptom
in the DSM and that was our mistake
and it needs to be returned to our understanding
I V DHT by emotional on pole to miss I mean this quickness to anger
to be easily excitable to have low frustration tolerance
to be easily angered by things around you
and to display your emotions much more quickly
than other people do now this is not a mood disorder even though it starts to
look like one
mood disorders are where you are generating too much emotion
but ADHD is is a failure to regulate normal
emotions it is a self regulation disorder
the feeling you're having is normal that you are not moderating it is not
it is this inability to self sues
to self com and to then moderate the emotion to be more acceptable for the
context
and for what you hope to accomplish here the goal that is at hand
your long-term welfare is at stake ken
you modified that emotion
to be more socially acceptable to be less costly
less damaging he that is as much a part of ADHD is anything else and we are
pushing the dsm-5 committees there are several
to re incorporate emotional impulsiveness
and this emotional dysregulation as being a part of this disorder because it
loads
on this dimension you can not be impulsive in your behavior and not be
impulsive in your emotions that is impossible because they are unity
they go together emotion is welded to
everything you say and do sometimes is benign
and bland other times it is powerful
an intense it is the emotional coloring
of the behavior we display if you are impulsive in one
you must be in the other that needs to get
reintroduced back into ADHD for a number of compelling reasons not just because
historically it was always there but because it explains so much more
than the current do you have ADHD explains as I will show you
ADHD children are eleven times more likely to develop
oppositional defiant disorder within two years at the onset of their ADHD
why what are those disorders have to do with each other now they're treated as
simply
co morbidity all well they go together but we're not sure
but if you put your motion back into ADHD you see the connection right in 20
DD
because everybody with ADHD is automatically sub clinically
OD'd at the get-go it on a gonna take one
more symptom to cross the diagnostic threshold
in other words ADHD causes oded
that is an important thing to understand because the OD'd
while it does have some social influences over it
half %uh DD is the inability to manage frustration
impatience and anger and that will set you up
for the second component AVO DD which is interaction
conflict defiance arguing
but the first four symptoms up the H in OD'd
our mood anger temper
hostility easily annoyed irritability
and that is part of ADHD so we need dsm-5
then we need families to both understand the emotion
goes with this disorder it is not a separate
comorbidity in some cases
and now we know why when we treat ADHD
particularly with the medications that we use we get nearly as much reduction
and OD'd
as we get an ADHD and when we don't
it is because of the social conflict component
which is learned and we will have to
unlearned that little piece but the mood component is he ADHD component
now by returning emotion into ADHD it also helps families to understand some
of the other life course risks
fifty to seventy percent of ADHD children are utterly rejected by close
friendships by second-grade
it is in fact one other more devastating consequences have this disorder
is this inability to make and keep close
sustained friendships with other children and it is
heartbreaking for parents to see this happening
but their child is not as liked as other children
that the sleepovers the going to the movies and the other social events
in which other children celebrate their peer relationships
are shut off for this trial why is it there
the single best predictor a peer rejection
is that symptom the emotional
impulsiveness friends forgive you your distractibility
your forgetfulness you're working memory problems
and even your restlessness they will not forgive your anger
your hostility the quickness with which you emote
to other people because it is offensive
it is socially costly so now we can begin to understand the numerous social
problems
that ADHD children are prone to because it arises from
this aspect above the inhibitory deficit
there are other things that it explains I could do a whole hour and a half as I
did a month ago in Toronto
on the importance of emotion in ADHD I won't go there
but suffice to say that it explains the road rage during driving
the job dismissals which are not the result %uh inattentiveness
but I being too quick to anger too quick to express raw emotion in the workplace
%uh which employers are not tolerant
especially if it occurs with a customer
and it also explains to us the marital difficulties
and the parenting difficulties these children may be prone to
because the single best predictor of marital problems in the adult with ADHD
is not distractibility it is a motion
so we can begin to paint a better picture understanding ADHD in its life
course Rhys
by understanding the nature of the inhibitory problem
and that it includes emotion
as part of it and not just slide 1 I've got 85 slide
do you see why i'm concerned. with
15 minutes to do is lie alright so we better get rolling here
but I thought you ought to know where we're going and by the way in case you
hadn't noticed
I will not talk down to you today I will treat you as if you were my colleagues
my students my peers
because I think the parents attend these things to learn
and that's not going to happen if I have to dumb this material down
and it is also insulting and I won't insult your intelligence either
you're knowledgeable people I'll speak to you frankly
using the scientific term on K