Attention ‑ Deficit/ Hyperactivity Disorder (ADHD; Chapter 15)

Definition of ADHD A neurobehavioral syndrome marked by inattention and/or hyperactivity and impulsivity (DSM-5)

Video Link How to Recognize ADHD Symptoms in Children How to Recognize ADHD Symptoms in Children

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 have Less education, including fewer college degrees Lower incomes Higher divorce rates More antisocial personality disorders More 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 During Pregnancy Sample: Danish children (N = 64,322) whose mothers used acetaminophen during pregnancy (data from the Danish National Birth Cohort during ) Results: Children were at higher risk for receiving a diagnosis of ADHD

Etiology of ADHD [4] Study of Acetaminophen Use During Pregnancy (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: /jamapediatrics

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 [1] Pharmacological Approximately 70% to 80% of children who exhibit hyperactive symptoms respond positively to stimulant medications

Interventions for ADHD [2] Behavioral Positive reinforcement Verbal praise Withdrawal of reinforcement Time out A response-cost program Point system Token economy

Interventions for ADHD [3] Behavioral (Cont.) Contracts between parents/teachers and children Stipulate desired and expected behaviors at home and/or at school Consequences for failure to perform the desired behaviors Cognitive-behavioral Self-monitoring programs

Interventions for ADHD [4] Family Parent training programs Educational Teaching new skills Establishing routines Promoting attention Improving study skills Improving memory

Interventions for ADHD [5] Educational (Cont.) Improving listening skills See Handout K-3 for suggestions (pp. 185 – 209 in RG)

Interventions for ADHD [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