Stephen P. Amos PhD Associate Professor Department of Pediatrics University of Kansas School of Medicine–Wichita

ADD vs. ADHD What’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 medication New books and websites

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

Assessment The 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 Deficit Developmental delay in inhibition Not being able to delay gratification Impaired self regulation

The Essential Deficit (cont.) Deficits in executive function Five components 1. 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 work 3. 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 actions 5. Complex problem solving Taking an issue apart, analyzing the pieces, reconstituting and organizing it into new ideas

KUSM–W Pediatric Residency ADHD Checklist

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

Treatment Options Medication 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 2. Most programs will involve teaching both child and parenting skills a. Developing attention skills (see: or 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 misbehave 2. Paying attention to the child 3. Increasing compliance and decreasing disruptiveness 4. When praise isn’t enough: Poker chips and points 5. Time out, assigning work, taking away privileges 6. Extending time out to other problems 7. Managing children in public places 8. Improving school performance 9. Handling future problems 10. 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 treatments a. Emwave and Heartmath (How to help your child and yourself) b. Omega 3’s c. Herbal treatments and red dye #2 d. Caffeine, etc. 4. Personality and ADHD, the role of psychological type

Treatment Options (cont.) Cognitive behavioral treatment 5. Some survival rules to consider a. Write everything down

Treatment Options (cont.) Cognitive behavioral treatment 5. Some survival rules to consider (cont.) b. Put everything where it belongs right away c. When you think of something that needs done do it, or write it down d. Double check yourself several times a day e. Let people help you, ask for help when you need it, and thank people when they help you f. Use things the way they were intended to be used g. 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 things i. Say no when you have to, which may be often j. When all else fails, see rule “A” a. Adapted from Mark Romereim’s Survival Rules for ADHD