attention ‑ deficit/ hyperactivity disorder (adhd; chapter 15)

Attention‑Deficit/Hyperactivity Disorder (ADHD; Chapter 15)

Definition of ADHD

A neurobehavioral syndrome marked by inattention and/or hyperactivity and impulsivity (DSM-5)

http://youtu.be/1GIx-JYdLZs

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How to Recognize ADHD Symptoms in How to Recognize ADHD Symptoms in ChildrenChildren http://youtu.be/1GIx-JYdLZs

Some Facts about ADHD [1]

In 2011 about 6.4 million children ages

4–17 years had parent-reported ADHD (about 11% of the U.S. population)

69% were taking medications (3.5 million children)

A 42% rate of increase from 2003 to 2011 Boys were more than twice as likely as

girls to have ADHD (12.1% vs. 5.5%)

Some Facts about ADHD [2]

Incidence in different ages Children younger than 10 years (6.8%) Children ages 11–14 years (11.4%) Children ages 15–17 years (10.2%)

33.2% fail to graduate from high school on time vs. 15.2% of children without any psychological disorder

DSM-5 Diagnostic Criteria for ADHD

Two main types of symptoms Inattention Hyperactivity and impulsivity

Three types of ADHD Combined presentation Predominately inattentive presentation Predominately hyperactive/impulsive

presentation

Disorders Comorbid With ADHD

[1] Children with ADHD represent a

heterogeneous population Often display a diversity of behavior

problem and have a comorbid disorder

Disorders Comorbid With ADHD

[2] Disorders Comorbid with ASD

Oppositional defiant disorder (about 40% to 50%)Conduct disorder (about 25%)Disruptive mood dysregulation (majority of children)Specific learning disorder (50% or more)Anxiety disorder (about 30%)

Disorders Comorbid With ADHD

[3] Disorders Comorbid with ASD (Cont.)

Depressive disorder (about 20%)Substance use disorder (minority of children)Obsessive-compulsive disorder (minority of children)Autism spectrum disorder (minority of children)

ADHD and Conduct Disorder [1]

A distinct subtype and may have a genetic basis

Increased risk for Antisocial behaviors Substance abuse Peer rejection Low self-esteem Depression Personality disorders

ADHD and Conduct Disorder [2]

Increased risk for (Cont.) Difficulties in processing social

information Suspension from school

ADHD and Conduct Disorder [3]

Parents and Familial Factors Parents face increased stress,

frustration, and despair Families tend to be nonintact and of low-

income Mothers are unhappy Parents are uninterested in their

children’s activities

Children with ADHD at Adulthood

Adults haveLess education, including fewer college degreesLower incomes Higher divorce ratesMore antisocial personality disordersMore substance-related disorders Increased risk for criminal behavior

Other Types of Deficits in ADHD

Cognitive deficits Including deficits in executive functions; see

Appendix M in RG (p. 246) Social and adaptive functioning deficits

Difficulty assuming responsibility Motivational and emotional deficits

Limited interest in achievement Motor, physical, and health deficits

Fine and gross-motor deficits

Etiology of ADHD [1]

No single cause but likely multiple factors Genetic factors

Runs in families Neurological factors

Different brain structures Imbalance or deficiency in one or more

neurotransmitters

Etiology of ADHD [2]

Prenatal factors Exposure of the fetus to

Nicotine Alcohol Other drugs Maternal psychosocial stress during

pregnancy Postnatal exposure to toxic substances

Lead, methylmercury, and pesticides

Etiology of ADHD [3]

Study of Acetaminophen Use Study of Acetaminophen Use During PregnancyDuring Pregnancy

Sample: Danish children (N = 64,322) whose mothers used acetaminophen during pregnancy (data from the Danish National Birth Cohort during 1996-2002)Results: Children were at higher risk for receiving a diagnosis of ADHD

Etiology of ADHD [4]

Study of Acetaminophen UseStudy of Acetaminophen Use

During Pregnancy (During Pregnancy (Cont.Cont.))Source: Liew, Z., Ritz, B., Rebordosa, C., Lee, P.-C., & Olsen, J. (2014). Acetaminophen use during pregnancy, behavioral problems, and hyperkinetic disorders. JAMA Pediatrics. Advanced online publication. doi:10.1001/jamapediatrics.2013.4914

Assessment of ADHD [1]

Comprehensive history Review of the child’s cumulative school

records Attendance history Reports of behavioral problems School grades Standardized test scores Number of schools attended

Assessment of ADHD [2]

Review of relevant medical information Review of previous psychological

evaluations Interviews with parents, teachers, and child Observations of child in classroom and

playground Administration of rating scales to parents,

teachers, and child

Assessment of ADHD [3]

Administration of psychological tests to child

See Appendix G (pp. 119–126) in RG for additional assessment forms

See pp. 460–465 in main text for additional information about assessment of ADHD

Evaluation of ADHD Assessment Findings [1]

Presence of inattention, hyperactivity, and impulsivity

Number, type, severity, and duration of symptoms

Situations in which symptoms are displayed

Verbal abilities Nonverbal abilities

Evaluation of ADHD Assessment Findings [2]

Short- and long-term memory abilities Other cognitive abilities

See Table L-18, p. 242 in RG for an executive functions checklist

Comorbid disorders Social competence Adaptive behavior Educational and instructional needs

Comment on Assessment of ADHD [1]

Diagnosis of ADHD is not easy Restlessness, inattention, and overactive

behavior are common in children Parents may find it difficult to judge child’s

behavior Rating scales usually do not provide for a

functional analysis of the variables that interact with children’s behaviors

Comment on Assessment of ADHD [2]

Teachers tend to assign more symptoms consistent with ADHD to younger children than to older children

Symptoms of ADHD can be displayed In different ways across different

settings In different relationships

Comment on Assessment of ADHD [3]

A comprehensive assessment requires a multi-method approach with Multiple informants Multiple contexts Multiple psychological tests Multiple use of rating scales See Table 25-1 in Chapter 25 (pp. 697–701

in main text) for questions to consider in preparing a report

Interventions for ADHD Interventions for ADHD [1][1]

Pharmacological Approximately 70% to 80% of children

who exhibit hyperactive symptoms respond positively to stimulant medications

Interventions for ADHD Interventions for ADHD [2][2]

Behavioral Positive reinforcement

Verbal praise Withdrawal of reinforcement

Time outA response-cost program

Point systemToken economy

Interventions for ADHD Interventions for ADHD [3][3]

Behavioral (Cont.) Contracts between parents/teachers and

children Stipulate desired and expected behaviors

at home and/or at schoolConsequences for failure to perform the

desired behaviors Cognitive-behavioral

Self-monitoring programs

Interventions for ADHD Interventions for ADHD [4][4]

Family Parent training programs

Educational Teaching new skills Establishing routines Promoting attention Improving study skills Improving memory

Interventions for ADHD Interventions for ADHD [5][5]

Educational (Cont.) Improving listening skills See Handout K-3 for suggestions (pp.

185–209 in RG)

Interventions for ADHD Interventions for ADHD [6][6]

Alternative interventions that have little scientific support

Dietary interventions Antimotion sickness medicines Manipulation of bones in the body Exercises to improve eye tracking Enhancing the ability to hear certain

frequencies of sound Neurofeedback