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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