Stephen P. Amos PhDAssociate Professor

Department of PediatricsUniversity of Kansas School of Medicine–Wichita

ADD vs. ADHDWhat’s the difference?

The short answer to this question is:

What’s New?Guidelines for

treatment and new tools for dealing with ADHD

Behavior management techniques

What’s New?Adult

treatment alternatives

What’s New?Knowledge of

medicationNew books and websites

What’s Not New?ADHD is realADHD doesn’t go awayOther problems are associated with ADHDIt’s long hard work to deal withThere are very effective treatments

AssessmentThe essential questions:

1. Are the behaviors in question excessive, long-term, and pervasive?

2. Are they a continuous problem, not just a response to a specific situation?

3. Do the behaviors occur in every setting?4. Have the behaviors been present prior to age

7, and continuous for at least 6 months?

The Essential DeficitDevelopmental delay in inhibition

Not being able to delay gratificationImpaired self regulation

The Essential Deficit (cont.)Deficits in executive function

Five components1. Working memory

Holding facts in mind while manipulating information; accessing facts stored in long term memory

The Essential Deficit (cont.)Deficits in executive function

Five components (cont.)2. Activation, arousal, and effort

Getting started, paying attention, finishing work3. Emotional control

Ability to tolerate frustration, thinking before acting or speaking

4. Internalizing language Using ‘self talk’ to control one’s behavior, and direct

future actions5. Complex problem solving

Taking an issue apart, analyzing the pieces, reconstituting and organizing it into new ideas

KUSM–W Pediatric ResidencyADHD Checklist

Other Key Parts of AssessmentBehavior rating scales parent/teacher/otherClinical interviewVerbal and written reports of school

performance and behaviorNeuropsychological testing (CPT, TOVA,

GDS, IVA)Medical evaluation; including hearing and

vision testingScreen for co-existing disorders such as:

Oppositional defiant disorderAnxiety or mood disorders

Treatment OptionsMedication management

1. Careful selection of medication based on patient history and risk profile

2. Clinical trials to achieve optimal results with minimal dosage

3. Careful monitoring of medication effects and side effects

4. Vigilance for signs of substance abuse

Treatment Options (cont.)Cognitive behavioral treatment

1. See www.additudemag.com2. Most programs will involve teaching both

child and parenting skillsa. Developing attention skills (see:

www.addwarehouse.com or www.childswork.com)b. Building self esteem (see: The Survival Guide for

Kids With ADD or ADHD by John Taylor; or Learning to Slow Down and Pay Attention by Kathleen Nadeau and Ellen Dixon)

c. Anger and frustration management using the STOP program

Treatment Options (cont.)Cognitive behavioral treatment

2. Most programs will involve teaching both child, and parenting skills

Treatment Options (cont.)Cognitive behavioral treatment

2. Most programs will involve teaching both child, and parenting skills

d. Steps for parents:1. Understanding why children misbehave2. Paying attention to the child3. Increasing compliance and decreasing disruptiveness4. When praise isn’t enough: Poker chips and points5. Time out, assigning work, taking away privileges6. Extending time out to other problems7. Managing children in public places8. Improving school performance9. Handling future problems10. One month and three month booster sessions (see: Your

Defiant Child by Russell Barkley and Christine Benton)

Treatment Options (cont.)Cognitive behavioral treatment

3. Alternative treatmentsa. Emwave and Heartmath (How to help your child

and yourself)b. Omega 3’sc. Herbal treatments and red dye #2d. Caffeine, etc.

4. Personality and ADHD, the role of psychological type

Treatment Options (cont.)Cognitive behavioral treatment

5. Some survival rules to considera. Write everything down

Treatment Options (cont.)Cognitive behavioral treatment

5. Some survival rules to consider (cont.)b. Put everything where it belongs right awayc. When you think of something that needs done do it, or

write it downd. Double check yourself several times a daye. Let people help you, ask for help when you need it, and

thank people when they help youf. Use things the way they were intended to be usedg. Never agree to anything without checking your calendar

first, then see rule “A”h. Watch what your hands are doing so you will know where

you put thingsi. Say no when you have to, which may be oftenj. When all else fails, see rule “A”

a. Adapted from Mark Romereim’s Survival Rules for ADHD