ADHD and the Polyvagal Theory / ep48 show notes

Updated: Mar 27



DSM-5 Criteria for ADHD


People with ADHD show a persistent pattern of inattention and/or hyperactivity–impulsivity that interferes with functioning or development:


Inattention:

Six or more symptoms of inattention for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:

  • Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.

  • Often has trouble holding attention on tasks or play activities.

  • Often does not seem to listen when spoken to directly.

  • Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).

  • Often has trouble organizing tasks and activities.

  • Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).

  • Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).

  • Is often easily distracted

  • Is often forgetful in daily activities.

Polyvagal ladder: climb up, then down

Functions up the ladder are lost and the functions at the bottom of the ladder are combined with safety, so they look different

Such as in shutdown, you don’t have the fight/flight energy

But when in shutdown and safety, it’s stillness/relaxation/meditation/sleep...

Inattention - cognitive functions are compromised when we are in sympathetic or shutdown


Hyperactivity and Impulsivity

Six or more symptoms of hyperactivity-impulsivity for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level:

  • Often fidgets with or taps hands or feet, or squirms in seat.

  • Often leaves seat in situations when remaining seated is expected.

  • Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).

  • Often unable to play or take part in leisure activities quietly.

  • Is often “on the go” acting as if “driven by a motor”.

  • Often talks excessively.

  • Often blurts out an answer before a question has been completed.

  • Often has trouble waiting their turn.

  • Often interrupts or intrudes on others (e.g., butts into conversations or games)

Low to moderate sympathetic activation without the mindfulness awareness of what the body needs; how to discharge

Movement without mindfulness is just movement; nothing actually changes or gets released

Fidgets can be really helpful

What i am doing with the younger kids in session now - leg band, fidget toys; not teaching them, but leading their attention


In addition, the following conditions must be met:

  • Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.

  • Several symptoms are present in two or more settings, (such as at home, school or work; with friends or relatives; in other activities).

Why wouldn’t it be present in all settings? A broken arm is broken anywhere you go. Diabetes is diabetes anywhere you go, right?

Cues of safety! Opportunities for energy discharge!

I always always always saw this with clients in therapy


  • There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.

  • The symptoms are not better explained by another mental disorder (such as a mood disorder, anxiety disorder, dissociative disorder, or a personality disorder).

  • The symptoms do not happen only during the course of schizophrenia or another psychotic disorder.


Like bipolar, there is no explanation of why. It’s assuming the bx simply exist on their own, unlike PTSD

But this might be from many different paths, which the last point sort of addresses as a possible other disorder

I always found a better dx or explanation. And I always saw the bx improve with simple interventions, parental co-regulation, added or changed structure in the home, basic therapy


Based on the types of symptoms, three kinds (presentations) of ADHD can occur:

  • Combined Presentation: if enough symptoms of both criteria inattention and hyperactivity-impulsivity were present for the past 6 months

  • Predominantly Inattentive Presentation: if enough symptoms of inattention, but not hyperactivity-impulsivity, were present for the past six months

  • Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of hyperactivity-impulsivity, but not inattention, were present for the past six months.


Reference

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Arlington, VA., American Psychiatric Association, 2013.


ANNOUNCEMENTS -


MESSAGE FROM A SUPER FAN

Hey Justin I have been following your podcast for the last few months, and what I’ve found now which is amazing, if I am falling down the ladder into shutdown or fight and flight, I have actually put your podcast on and just your voices bring me back up the ladder to slightly more safe and social. So powerful . Thankyou x Eli


Connect on LinkedIn - https://www.linkedin.com/in/justinlmft


Fidgets Blog - https://www.justinlmft.com/post/fidgets


AD/HD Criteria from the CDC - https://www.cdc.gov/ncbddd/adhd/diagnosis.html


Intro/Outro music & Transition Sounds by Benjo Beats - https://soundcloud.com/benjobeats




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