Attention-Deficit/Hyperactivity Disorder

1. Attention-Deficit/Hyperactivity Disorder

2. What is ADHD? • Attention-Deficit/Hyperactivity Disorder • No longer called ADD • Characterized by age-inappropriate inattention, hyperactivity, and impulsivity • Considered a biological disorder • Children with ADHD likely have at least 1 parent with ADHD

3. How common is ADHD? • Affects about 4 to 6% of school-aged children • At least 1 childin every regular education classroom. • Contrary to popular belief, ADHD is under-diagnosed. • Gender differences • Males are 2.5-5.6 times more likely to be diagnosed. • Ethnic & cultural differences • Similar prevalence rates in other countries, depending on criteria used. • Differences in expectations of behavior may influence diagnosis.

4. DSM-IV Symptoms of Inattention (IA) • Poor attention to details/makes careless errors • Difficulty sustaining attention • Does not seem to listen when being spoken to directly • Does not follow through on instructions/fails to finish tasks • Difficulty organizing tasks and activities • Avoids tasks that require sustained mental effort • Loses things necessary for tasks or activities • Easily distracted by extraneous stimuli • Forgetful in daily activities

5. DSM-IV Symptoms of Hyperactivity/Impulsivity (H/I) • Difficulty playing or engaging in activities quietly • Always "on the go“/ "driven by a motor” • Talks excessively • Blurts out • Difficulty waiting in lines or awaiting turn in games • Interrupts or intrudes on others • Runs about or climbs on things inappropriately • Fidgets with hands or feet or squirms in seat • Leaves seat in situations in which remaining seated is expected

6. DSM-IV Criteria for ADHD • At least 6 symptoms of Inattention and/or Hyperactivity-Impulsivity lasting >6 months. • Symptoms present before age seven. • Symptoms are present in at least two settings (e.g., school, home). • Significant impairment in social, academic, or occupational functioning. • Not due to another disorder.

7. DSM-IV ADHD Subtypes • Predominantly Inattentive Type • At least 6 inattentive symptoms. • Less noticeable by parents and teachers than other types. • Predominantly Hyperactive-Impulsive Type • At least 6 Hyperactive-Impulsive symptoms. • More common in younger children. • Combined Type • At least 6 symptoms of IA and 6 symptoms of H/I. • Most common subtype. • Highest level of associated impairment.

8. Associated Problems • Negative relationships with parents & teachers • Negative relationships with peers & siblings • Poor academic functioning • Poor self-esteem • Higher likelihood of developing defiant, oppositional and/or aggressive behavior problems

9. Evidence-Based Treatments for ADHD • Behavior modification • Behavioral Parent Training • Behavioral Classroom Interventions • Stimulant medication • Combined treatment • Behavioral-pharmacological interventions

10. Behavior Modification • Behavioral Parent Training • Teaches parents skills to help manage child’s behavior, reduce parent-child conflict, and cope with difficulties of raising a child with ADHD. • Helps parents implement “token economy” in the home for problematic behavior. • Behavioral Classroom Interventions • Focus on implementing behavior modification program that targets behaviors that interfere with learning • E.g., providing rewards for on-task behaviors

11. Stimulant Medication • Extensive research has shown that stimulants: • Are a highly effective short term treatment. • Decrease disruption in the classroom. • Increase academic productivity and on-task behavior. • Improve teacher ratings of behavior. • However… • Stimulants may reduce symptoms, but do not improve all areas of impairment. • If used, stimulants should always be combined with behavior management.