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Introduction to ADHD: learn about the impact, diagnosis, and features of ADHD

Learn about the etiology of the disorder Learn about the comorbidities with ADHD Learn about the common medications

used in treatment Learn about psychosocial therapies that

are evidence-based Discuss some classroom management than

can help the child in the school setting.

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A condition where people have difficulty with inattention, hyperactivity, impulsivity, regulating their mood, and organization.

ADHD is a brain disorder. Scientists have shown that there are differences in the brains of children with ADHD.

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Problem solving Memory Language Motivation Judgment Impulse control Social behavior Planning

Decision-making Attention Ability to delay

gratification Time perception

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Brain is made up of nerve cells (neurons) that transmit signals in the brain

The signals travel in groups of nerve cells called “networks”

Networks involved: reward, focus, planning, attention, shifting between tasks, and movement.

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Affects about 5% of school-aged children

Psychiatric comorbidities are common Pathway risk

Pattern of inattention and/or hyperactivity-impulsivity lasting at least 6 months

Symptoms must be present before the age of 12 years old.

Symptoms must be present in at least 2 settings

Symptoms must interfere with social, academic, or occupational functioning

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Fails to give close attention to details or makes careless mistakes

Difficulty sustaining attention Does not seem to listen Difficulties in organizing tasks or activities Avoids or dislikes tasks that require sustained

mental effort (like HW) Does not follow instructions and fails to finish

work/chores Often loses things Forgetful in daily activities Easily distracted by extraneous stimuli

Fidgets with hands or feet Often leaves seat Often runs or climbs excessively (or feels

restless) Has difficulty playing or engaging in leisure

activities quietly Talks excessively Blurts out answers Has a difficult time waiting for their turn Interrupts others

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Likely involves dysfunction in the frontostriatal, cingulate, and cerebellar circuits› Inhibitory control› Response variability› Motor timing› Response to reward

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Perinatal stress Low birth weight Traumatic brain injury Maternal smoking during pregnancy,

prenatal exposure to alcohol or cocaine. Severe early deprivation Heavy metal poisoning (lead) Familial risk

› If the parent has ADHD, the child has >50% chance of also having ADHD

Oppositional Defiant Disorder: 45%-65% Learning Disorder: 20%-30% Anxiety Disorder: 25%-30% Bipolar Disorder, in older adolescents:

16%-23% Conduct Disorder: 8%-25% Tic Disorder: 8%-34% Depressive Disorder: 10%-18%

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Connor’s is the gold standard- adjusted for age and gender

Vanderbilt rating scales Inattention/Overactivity with Aggression

(IOWA) Attention tests

› Connors Continuous Performance Test› Test of Variable Attention

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4 groups: stimulant alone, behavioral treatment alone, combination treatment, community treatment

Stimulant alone and combination treatment groups had the best response in decreasing ADHD

Combination treatment most effective in treating associated syndromes: oppositional behaviors, anxiety symptoms, social skills, and academics

Stimulants Non-stimulants

› Strattera› Alpha-2 adrenergic agonists

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Stimulant efficacy › 75% of children benefit› 90% response after 2 medication trials

Side effects: loss of appetite, poor sleep, headaches, dyspepsia, tics, low growth rate, and exacerbation of psychosis

Discontinuation› Can be tapered without significant

withdrawal

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Evidence-based treatments› Behavior therapy: teacher and parents are

trained and they implement the behavior modification Behavioral parent training (BPT) Behavioral classroom management (BCM)

Other treatment› Cognitive therapy: more effective in

adolescents› Social skills training: not as effective› Neuro/bio-feedback: may be an option

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Ask if your child is having any problems in school or on the playground.

Say that your child has ADHD, a common childhood illness.

List any medications your child takes. Explain any other treatments, such as

behavior therapy. Find out if your child can get any special

services to help with learning.

Make your request in writing. Include your name, your child’s name,

the date, and your reason for requesting an evaluation.

Keep a copy of the letter for your own files.

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Most children with ADHD have some problem with academic performance (often what brings them to clinical attention).

Some will need and individual educational plan or even a special class or resource room

20%-25% have comorbid learning disorders Educational for All Handicapped Act,

Individuals with Disabilities Education Act or Section 504 of the Civil Rights Act.

504 Plan is an individually designed plan that includes a list of accommodations › Preferential seating› Increased time on tests› Reduced homework load› Extra supervision› Select appropriate group partners› Verbal and visual cuing “parallel teaching”› Help with organizational skills (daily report

card)

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Schedule the day. Have the same routine each weekday, from wake-up time to bedtime. Include homework time, outdoor and indoor playtime, and family mealtimes. Post the schedule on your refrigerator or a bulletin board in the kitchen. When you need to make a change, try to schedule it as far in advance as possible.

Organize essential items. Designate places for your child’s clothing, backpack, and school supplies. Keep everything in its place.

Use home work and notebook organizers. Stress the importance of writing down assignments and bringing books home that will be needed.

Provide structure and praise. Children with ADHD need consistent rules that they can understand and follow. When your child follows rules correctly, offer small rewards. Children with ADHD often receive criticism, so they expect negative feedback. Look for good behavior and praise it.

List household chores. Include space for your child to check off a chore after completing it.

Sample Chore Charts

Daily ChoresM T W Th F S Su

Set Dinner TableFeed Cats

Saturday ChoresDate Date Date Date Date

Take Out GarbageStraighten BedroomRecycle Newspapers

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Use time-outs effectively Manage non-compliant public behavior Use a daily school report card Anticipate future misbehavior Parents need to be treated if they also

have ADHD as well Classroom management: positive

reinforcement (immediate rewards for positive behavior)

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Dietary Intervention- no conclusive evidence

Mega-vitamins and mineral supplements Anti-motion sickness medication Chronic yeast infection treatments Applied kinesiology Optometric vision training

Attention-deficit/hyperactivity disorder (ADHD) is a neurobiological disorder

When ADHD is associated with comorbidity- complicates treatment

The principal treatment for ADHD is pharmacological.

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Treatment is protective against substance use› Children with ADHD not treated with

stimulants have a higher risk of substance abuse than those who are treated

Higher rates of the following:› Motor vehicle accidents› Injury and higher medical expenses› Earlier sexual activity and teen pregnancy› Lower academic attainment, higher rates of

suspension and dropping out› Occupational, social, marital, and parenting

problems› Increased crime rate

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1. The easier, cheaper, and safer a treatment is, the less evidence is needed to justify an individual trial, especially if it can be done along with a proven standard treatment. Risky treatments need controlled convincing evidence.

2. Look for controlled trials in well-characterized samples, not anecdotes or testimonials. A major flaw in many published alternative/complementary treatment studies is lack of diagnostic rigor, second only to lack of controls.

3. Herbs are crude drugs (if they work) and can have interactions with other drugs, either prescription or over the counter. Most families do not realize this because herbs are peddled as “nutritional” and “natural” or “dietary supplements,” which most people mistakenly interpret as perfectly safe. Some herbs, with further research, may indeed be found useful for treatment of ADHD, and may contain psychoactive chemicals, such as nicotine from tobacco leaf, that can be refined into useful drugs. For now, the unknown risk appears to exceed any proven benefit.

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4. Remember that delay of proven treatment is a risk, varying in seriousness with the urgency of the presenting clinical picture.

5. If the treatment is easy, cheap, and safe, there would seem little harm in accepting a trial

6. When any treatment (including standard treatments) is tried, it is important to document the effect. Some rating scale or behavior count at baseline can be repeated periodically to see if there is reasonable progress.

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https://youtu.be/OMCy9684SbE

American Academy of Child and Adolescent Psychiatry (AACAP) http://www.aacap.org

American Academy of Pediatrics (AAP) http://www.aap.org

Centers for Disease Control and Prevention (CDC) http://www.cdc.gov

National Alliance on Mental Illness (NAMI) http://www.nami.org