Distinguishing ADHD: Disorder, Symptoms, and Impairment Aspect Definition Examples Disorder Neuro-genetic origins ADHD diagnosis requires meeting specific DSM-5 criteria (e.g., symptom count, duration, and impact). Symptoms Cognitive-behavioral expressions –       Inattention –       Hyperactivity –       Impulsivity –       Deficient Executive Functioning Impairment The functional consequences of ADHD symptoms in the natural ecology – The Environment ´´Kicking Back´´ –       Poor academic performance due to inability to focus. –       Difficulty maintaining relationships due to impulsive behaviors. –       Workplace challenges like missed deadlines. The “bull curve” is a way to show how people with ADHD perform on tasks that require executive functions (EF), like attention, memory, planning, and impulse control, compared to people without ADHD. It helps us understand that people with ADHD can have a wide range of abilities when it comes to these tasks. Key Points: Executive Functions (EF): These are the mental skills needed to plan, focus, remember things, and control impulses. For example, working memory, flexibility, and self-control. ADHD and EF: People with ADHD often struggle with EF tasks, such as focusing or organizing tasks, but their challenges can vary widely. The Bull Curve: The curve shows a typical pattern where most people without ADHD perform well on EF tasks. For people with ADHD, there is a broader range of abilities. Some may struggle a lot, while others may do just fine or even excel in certain areas. Treatment Implications: Since people with ADHD have different levels of EF abilities, treatment needs to be personalized. What works for one person might not work for another, and each person may need support in different areas. ADHD Varies by Setting: Better here Worse Here Fun: Engaging and enjoyable activities help sustain focus and motivation for individuals with ADHD. Immediate: Quick feedback or rewards help keep attention focused and prevent distractions. Frequent: Regular changes or variations in tasks can prevent boredom and maintain engagement. High: High-energy or stimulating environments enhance alertness and attention. Early: Morning or early parts of the day are often when individuals with ADHD are most focused and productive. Supervised: Close supervision provides structure and accountability, improving task completion and focus. One-to-one: Personalized, one-on-one interactions reduce distractions and allow for better focus. Novelty: New or unfamiliar tasks create curiosity and can boost engagement and concentration. Fathers: Some individuals with ADHD may respond better to the parenting style of fathers, which can provide additional structure or stimulation. Strangers: Interactions with unfamiliar people or in new environments may serve as stimulating challenges, helping to improve focus. Clinic Exam Room: A structured, quiet setting like a clinic exam room can promote focus and reduce distractions. Boring: Monotonous or repetitive tasks lead to boredom and difficulty maintaining focus. Delayed Consequences: Tasks with rewards or outcomes that are delayed make it harder to stay engaged and motivated. Infrequent Feedback: Lack of regular feedback or recognition can lead to disengagement and reduced focus. Low Salience: Tasks that feel irrelevant or have little personal importance are harder to focus on. Late in the Day: Fatigue toward the end of the day can reduce attention and make it harder to stay focused. Unsupervised: Without supervision or structure, individuals with ADHD may struggle to stay on task and may become distracted. Group Situation: Group environments can be distracting and make it harder for individuals to focus due to competing stimuli. Familiarity: Familiar tasks or environments may be too routine, leading to a lack of interest and reduced concentration. Mothers: Some individuals may be less responsive to the familiar structure provided by mothers, possibly due to comfort or lack of challenge. Parents: Similar to mothers, interactions with parents can sometimes reduce motivation or focus due to the familiarity of the relationship. Waiting Room: A passive, unstructured setting like a waiting room can lead to restlessness and a loss of focus due to boredom and inactivity. Prevalence of ADHD: In Children: Global prevalence: Around 5-7%. Gender differences: Boys > Girls (3:1). In Adults: Global prevalence: Around 5-5%. Gender differences: Men > Women (1.5:1). Somewhat more common in middle to lower-middle classes. More common in population dense areas For instance, 12-15 % of U.S. military dependents (DSM-III-R) Expect of Life Expectancy: Greater Child Externalizing Behaviors: Children with more externalizing behaviors (e.g., impulsivity, aggression) linked to ADHD have a 5 to 2 times greater risk of mortality by adulthood. Increased Mortality Risk in Adults: Adults with ADHD are 8 times more likely to die earlier than the general population, with the risk being 4.5-6 times higher in adulthood. They are 3 times more likely to die from accidents. Contributors to Shortened Life Span: Higher risks: Smoking, alcohol, and substance abuse. Increased aggression and involvement in crime. Higher suicide risk and greater obesity risk. Lower health status. These are often associated with low conscientiousness, which is common in those with ADHD. Childhood Conscientiousness: Low conscientiousness in childhood is linked to earlier death by all causes, with children in the <25th % of conscientiousness losing up to 7 years of life expectancy. Impact of ADHD on Life Expectancy: Due to the connection between ADHD and low conscientiousness, individuals with ADHD face a greater reduction in life expectancy. Reduction in Life Expectancy: Childhood ADHD reduces life expectancy by 9 years by age 27. If ADHD persists into adulthood, this reduction can be as high as 13 years. Comorbid Disorders in ADHD: Anxiety Disorders: Individuals with ADHD are more likely to experience anxiety disorders such as generalized anxiety, social anxiety, and panic disorder, often due to difficulties with attention and impulse control. Depressive Disorders: Depression is common in people with ADHD, particularly in adulthood. Overlapping symptoms such as low energy and mood swings can complicate diagnosis. Substance Use Disorders: Untreated ADHD increases the risk of alcohol and drug misuse, as impulsivity and emotional regulation difficulties contribute to substance abuse. Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD): Children with ADHD may develop oppositional or aggressive behaviors, which can escalate into conduct disorder if untreated. Learning Disabilities: ADHD often co-occurs with learning disabilities, especially in reading, writing, and math,

The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) outlines specific criteria for the diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD). Here’s a summary of the key points: Persistent Pattern of Inattention and/or Hyperactivity-Impulsivity Symptoms interfere with functioning or development and fall into two categories: Inattention and Hyperactivity-Impulsivity. Symptoms Present Before Age 12 There must be evidence that the symptoms were present before the age of 12. Symptoms Present in Two or More Settings Examples: home, school, work, or social settings. Symptoms Interfere with Functioning Symptoms must cause significant impairment in social, academic, or occupational functioning. Symptoms Are Not Better Explained by Another Disorder For example, symptoms are not solely attributable to psychotic disorders, mood disorders, or substance use. Presentations of ADHD: Predominantly Inattentive Presentation: Criteria for inattention are met, but not for hyperactivity-impulsivity. Predominantly Hyperactive-Impulsive Presentation: Criteria for hyperactivity-impulsivity are met, but not for inattention. Combined Presentation: Criteria for both inattention and hyperactivity-impulsivity are met. Severity Levels: Mild: Few symptoms beyond the minimum required for diagnosis; minor impairment. Moderate: Symptoms and impairment between mild and severe. Severe: Many symptoms in excess of the diagnostic threshold; marked impairment. Persistent Pattern of Inattention vs. Hyperactivity-Impulsivity: Inattention: o   At least 6 symptoms (<17 years old) or 5 symptoms (≥17 years old). o   Symptoms persist for ≥ 6 months and are inappropriate for developmental level. Hyperactivity and Impulsivity: o   At least 6 symptoms (<17 years old) or 5 symptoms (≥17 years old). o   Symptoms persist for ≥ 6 months and are inappropriate for developmental level. 1.    Fails to give close attention to details or makes careless mistakes. 1.    Fidgets with hands or feet or squirms in seat. 2.    Difficulty sustaining attention in tasks or play activities. 2.    Leaves seat in situations when remaining seated is expected. 3.    Does not seem to listen when spoken to directly. 3.    Runs about or climbs in inappropriate situations (restlessness in adolescents or adults). 4.    Does not follow through on instructions and fails to finish schoolwork, chores, or workplace duties. 4.    Unable to play or engage in leisure activities quietly. 5.    Difficulty organizing tasks and activities. 5.    Often “on the go,” acting as if “driven by a motor.” 6.    Avoids or dislikes tasks requiring sustained mental effort. 6.    Talks excessively. 7.    Often loses things necessary for tasks or activities. 7.    Blurts out answers before a question has been completed. 8.    Easily distracted by extraneous stimuli. 8.    Difficulty waiting their turn. 9.    Often forgetful in daily activities. 9.    Interrupts or intrudes on others (e.g., butts into conversations or games).  Understanding the Hyperactivity-Impulsivity Symptoms: Deficient motor inhibition (restless, hyperactivity) Impaired verbal inhibition (excessing talking, interrupting) Impulsive cognition (Difficulty suppressing task irrelevant thoughts, rapid decision making) Impulsive motivation (prefer immediate gratification, greater discounting of delayed consequences) Emotion dysregulation (impulsive affect; poor ´´top down´´ emotional self-regulation) Restlessness decreases with age, becoming more internal, subjective by adulthood  Understanding the Inattention Symptoms: But 6 types of attention exist – not all are impaired in ADHD Executive Attention (& Functioning) Poor persistence toward goals, tasks, and the future (can´t sustain attention/action over time) Distractible (impaired resistance to responding to goal-irrelevant external and internal events) Deficient task re-engagement following disruptions (skips across uncompleted tasks) Impaired working memory (forgetful in daily activities, cannot remember what is to be done) Diminished self-monitoring What is Underlying Nature of the Disorder? Deficiencies in the brain´s executive functions – the suite of mental mechanisms that permit self-regulation and the cross-temporal organization of behavior toward the future They are types of self-directed behavior that modify automatic behavior so as to alter later consequences: Self-awareness Inhibition or self-restraint Working memory (nonverbal and verbal) Emotional self-regulation Self-motivation Planning and problem-solving

Melatonin isn’t just a sleep hormone; it’s your body’s natural timekeeper, helping to regulate when you feel awake and when you drift off. But did you know that the timing of melatonin matters just as much as the dose? Whether you’re battling jet lag, managing a sleep disorder, or adjusting to shift work, learning when to take melatonin can make all the difference. Let’s dive into how timing impacts its effects and how you can use it to your advantage. Timing is Everything: What Happens When You Take Melatonin When You Take Melatonin What Happens to Your Body Clock Why It Works How You Can Use It Early Evening (Before Natural Melatonin Rise) Advances your sleep schedule (you’ll feel sleepy earlier) Signals your body that it’s nighttime, kickstarting your natural sleep processes. – Perfect for night owls who need to sleep earlier. – Great for delayed sleep phase syndrome (DSPS). Early Morning Delays your sleep schedule (you’ll feel sleepy later) Tricks your body into thinking it’s still nighttime, keeping you in a sleep-friendly state. – Ideal for early birds who wake up too soon. – Helps manage advanced sleep phase syndrome (ASPS). Evening (Just Before Natural Melatonin Rise) Provides the strongest “time-shift” effect Enhances your body’s natural sensitivity to melatonin at this time. – The go-to for resetting after eastward travel. – Helps shift workers align their schedules. How Melatonin Works Its Magic Your internal clock, known as the circadian rhythm, is controlled by a tiny part of your brain called the suprachiasmatic nucleus (SCN). Melatonin communicates directly with the SCN to shift your body’s timing: Early Evening (Before Natural Melatonin Rise): Think of this as a gentle nudge, telling your body, “Hey, it’s almost bedtime!” Ideal for those who struggle to fall asleep early or need to adapt to an earlier schedule. Early Morning: This works like a snooze button for your circadian rhythm, telling your body it’s still night. Best for those who want to extend their sleep or shift their wake-up time later. Evening (Just Before Natural Melatonin Rise): The timing sweet spot! Your body’s natural sensitivity to melatonin is at its peak, making it the most effective time to shift your sleep-wake cycle forward. Perfect for tackling jet lag or adapting to new time zones. Why Timing Matters for You Melatonin isn’t a one-size-fits-all solution. Tailoring your timing can unlock its full potential: Struggling with Sleep Disorders? Delayed Sleep Phase Syndrome (DSPS): Evening melatonin helps night owls fall asleep earlier. Advanced Sleep Phase Syndrome (ASPS): Morning melatonin extends your wakefulness window. Traveling Across Time Zones? Eastward travelers benefit most from evening melatonin to adjust to earlier time zones. Working Odd Hours? Shift workers can use melatonin to sync their sleep schedules with unconventional work hours. Take Control of Your Sleep Melatonin isn’t just about falling asleep—it’s about mastering your internal clock. Here’s the secret: Evening doses shift your sleep earlier. Morning doses push your sleep later. Perfect timing maximizes its effects. By understanding the timing, you can use melatonin to align your sleep schedule with your lifestyle and feel more in sync with your day.

Behavioral Approaches: The Secret to Beating Insomnia Naturally Tired of tossing and turning at night? Say goodbye to sleepless nights with proven behavioral strategies that help you fall asleep, stay asleep, and wake up refreshed. Here’s your ultimate guide to reclaiming restful nights! 🌙 1. Stimulus Control: Reset Your Sleep Connection Turn your bed into a sleep sanctuary with these five simple steps: 🛌 Only go to bed when sleepy. 🌟 Can’t sleep? Leave the bed! Return only when you feel drowsy. ⏰ Wake up at the same time every day, no matter how well you slept. 💤 Bed = Sleep. Skip the TV, scrolling, or snacking in bed. 🚫 No naps! Save all your sleep energy for nighttime. ⏱️ 2. Sleep Restriction Therapy: Less is More Get the most out of your sleep by aligning your time in bed with how long you actually sleep: Start with your average sleep time over the past two weeks. Feeling better? Add 15–30 minutes every two weeks. If sleeplessness returns, dial back to the last effective schedule. 🧘‍♀️ 3. Relaxation Therapy: Calm Your Mind, Relax Your Body Stress and tension don’t belong in bed. Try these powerful techniques: 💪 Progressive Muscle Relaxation (PMR): Tense, then relax each muscle group to melt away stress. 🌅 Imagery & Autogenic Training: Picture serene landscapes or repeat calming affirmations. 🌬️ Deep Breathing: Inhale deeply, exhale slowly, and feel the relaxation wash over you. 🌀 4. Paradoxical Intention: Outwit Insomnia Here’s a trick: Try to stay awake on purpose! This takes the pressure off falling asleep and helps you drift off naturally. 🧠 5. Cognitive Therapy: Rewire Your Thoughts Your mind can be your biggest sleep ally—or enemy. Change your perspective: 📝 Thought Records: Write down your sleep worries, then challenge and reframe them. ❓ Socratic Questioning: Ask yourself: “Is this really true? What’s the evidence?” 🔬 Behavioral Experiments: Test your sleep beliefs in real life to see what truly works. 🛑 6. Counterarousal Therapy: Quiet a Busy Mind Stop overthinking before bed with these simple strategies: 🛀 Buffer Zone: Enjoy a relaxing bedtime ritual like reading or taking a warm bath. ✍️ Worry Hour: Schedule a specific time earlier in the day to tackle your stressors. 🌸 Mindfulness: Practice meditation or deep breathing to let go of daily tension. 🛏️ 7. Sleep Hygiene: Habits for Sweet Dreams Good sleep starts with great habits! Here’s what to do: ☕ Cut caffeine after lunch. 🚭 Reduce nicotine and alcohol. 💪 Exercise regularly—but not too close to bedtime. 🌘 Make your bedroom dark, quiet, and cool. 💡 8. CBT for Insomnia: The Gold Standard Cognitive Behavioral Therapy for Insomnia (CBT-I) combines everything: ✅ Stimulus control ✅ Sleep restriction ✅ Cognitive therapy ✅ Counterarousal strategies This science-backed approach transforms sleepless nights into restful ones 🌟 9. Mindfulness: Be Present, Sleep Better Daily mindfulness helps you stay in the moment, reduce stress, and quiet your racing thoughts. A calm mind = better sleep.