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ATTENTION DEFICIT/HYPERACTIVITY DISORDER (ADHD)

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  1. ATTENTION DEFICIT/HYPERACTIVITY DISORDER (ADHD) Stephen P. Amos PhD Associate Professor Department of Pediatrics University of Kansas School of Medicine–Wichita

  2. ADD vs. ADHD • What’s the difference? • The short answer to this question is: NONE

  3. What’s New? • Guidelines for treatment and new tools for dealing with ADHD • Behavior management techniques

  4. What’s New? • Adult treatment alternatives

  5. What’s New? • Knowledge of medication • New books and websites

  6. What’s Not New? • ADHD is real • ADHD doesn’t go away • Other problems are associated with ADHD • It’s long hard work to deal with • There are very effective treatments

  7. Assessment • The essential questions: • Are the behaviors in question excessive, long-term, and pervasive? • Are they a continuous problem, not just a response to a specific situation? • Do the behaviors occur in every setting? • Have the behaviors been present prior to age 7, and continuous for at least 6 months?

  8. The Essential Deficit • Developmental delay in inhibition • Not being able to delay gratification • Impaired self regulation

  9. The Essential Deficit (cont.) • Deficits in executive function • Five components • Working memory • Holding facts in mind while manipulating information; accessing facts stored in long term memory

  10. The Essential Deficit (cont.) • Deficits in executive function • Five components (cont.) • Activation, arousal, and effort • Getting started, paying attention, finishing work • Emotional control • Ability to tolerate frustration, thinking before acting or speaking • Internalizing language • Using ‘self talk’ to control one’s behavior, and direct future actions • Complex problem solving • Taking an issue apart, analyzing the pieces, reconstituting and organizing it into new ideas

  11. KUSM–W Pediatric ResidencyADHD Checklist

  12. Other Key Parts of Assessment • Behavior rating scales parent/teacher/other • Clinical interview • Verbal and written reports of school performance and behavior • Neuropsychological testing (CPT, TOVA, GDS, IVA) • Medical evaluation; including hearing and vision testing • Screen for co-existing disorders such as: • Oppositional defiant disorder • Anxiety or mood disorders

  13. Treatment Options • Medication management • Careful selection of medication based on patient history and risk profile • Clinical trials to achieve optimal results with minimal dosage • Careful monitoring of medication effects and side effects • Vigilance for signs of substance abuse

  14. Treatment Options (cont.) • Cognitive behavioral treatment • See www.additudemag.com • Most programs will involve teaching both child and parenting skills • Developing attention skills (see: www.addwarehouse.com or www.childswork.com) • 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) • Anger and frustration management using the STOP program

  15. Treatment Options (cont.) • Cognitive behavioral treatment • Most programs will involve teaching both child, and parenting skills

  16. Treatment Options (cont.) • Cognitive behavioral treatment • Most programs will involve teaching both child, and parenting skills • Steps for parents: • Understanding why children misbehave • Paying attention to the child • Increasing compliance and decreasing disruptiveness • When praise isn’t enough: Poker chips and points • Time out, assigning work, taking away privileges • Extending time out to other problems • Managing children in public places • Improving school performance • Handling future problems • One month and three month booster sessions (see: Your Defiant Child by Russell Barkley and Christine Benton)

  17. Treatment Options (cont.) • Cognitive behavioral treatment • Alternative treatments • Emwave and Heartmath (How to help your child and yourself) • Omega 3’s • Herbal treatments and red dye #2 • Caffeine, etc. • Personality and ADHD, the role of psychological type

  18. Treatment Options (cont.) • Cognitive behavioral treatment • Some survival rules to consider • Write everything down

  19. Treatment Options (cont.) • Cognitive behavioral treatment • Some survival rules to consider (cont.) • Put everything where it belongs right away • When you think of something that needs done do it, or write it down • Double check yourself several times a day • Let people help you, ask for help when you need it, and thank people when they help you • Use things the way they were intended to be used • Never agree to anything without checking your calendar first, then see rule “A” • Watch what your hands are doing so you will know where you put things • Say no when you have to, which may be often • When all else fails, see rule “A” • Adapted from Mark Romereim’s Survival Rules for ADHD

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