Attention Deficit Disorder December 8, 2004

Attention Deficit Hyperactivity Disorder: DSM-IV-TR ADHD: combined type ADHD: combined type ADHD: predominantly inattentive type ADHD: predominantly inattentive type ADHD: predominantly hyperactive-impulsive type ADHD: predominantly hyperactive-impulsive type

Prevalence Data Approximately 3-7% of school-aged children have ADHD. Approximately 3-7% of school-aged children have ADHD. Estimates that 23-50% of children receiving clinical services have ADHD. Estimates that 23-50% of children receiving clinical services have ADHD. Occurs more frequently in males than females Occurs more frequently in males than females 3:1 non-clinic samples 3:1 non-clinic samples 6:1 clinic samples 6:1 clinic samples

Etiology Genetic Component Genetic Component Twin studies: 51% concordance for monozygotic twins; 33% in dizygotic twins. Twin studies: 51% concordance for monozygotic twins; 33% in dizygotic twins. Brain Functioning Brain Functioning Decreased activity of inhibitory areas of the brain (e.g., prefrontal cortex). Decreased activity of inhibitory areas of the brain (e.g., prefrontal cortex). Impairments on executive function tasks. Impairments on executive function tasks.

ADHD Comorbidity Learning Disorders: 25-50% Learning Disorders: 25-50% Oppositional Defiant Disorder: 35% Oppositional Defiant Disorder: 35% Conduct Disorder: 26% Conduct Disorder: 26% Depressive Disorder: 18% Depressive Disorder: 18% Anxiety Disorder: 26% Anxiety Disorder: 26%

ADHD Diagnostic Evaluation Parent Interview Parent Interview Parent & Teacher Ratings (broad and narrow) Parent & Teacher Ratings (broad and narrow) Intellectual Assessment Intellectual Assessment Achievement Testing Achievement Testing

Issues in Diagnosing ADHD Age of onset – must be prior to 7 years Age of onset – must be prior to 7 years Developmental level – must be inconsistent with child’s mental age Developmental level – must be inconsistent with child’s mental age Symptoms must be present in two or more settings Symptoms must be present in two or more settings Medical confounds – must not be due to side effects associated with medical conditions or medications Medical confounds – must not be due to side effects associated with medical conditions or medications Family/environmental confounds – rule out family stress, anxiety, depression as cause of symptoms Family/environmental confounds – rule out family stress, anxiety, depression as cause of symptoms

Performance-Based Assessment of ADHD (Rapport et al., 2000) Continuous Performance Test Continuous Performance Test X only – discriminated between ADHD and non- ADHD on 18/21 studies (86%) X only – discriminated between ADHD and non- ADHD on 18/21 studies (86%) AX – 28/31 studies (93%) AX – 28/31 studies (93%) Stop Signal (7/9 studies, 78%) Stop Signal (7/9 studies, 78%) WISC-R Arithmetic (3/4 studies, 75%) WISC-R Arithmetic (3/4 studies, 75%) WISC-R Coding (3/4 studies, 75%) WISC-R Coding (3/4 studies, 75%) Argue that all of these tasks involve working memory. Argue that all of these tasks involve working memory.

Behavioral Assessment Scale for Children (BASC) 3 informant versions provide comparisons across multiple informants: 3 informant versions provide comparisons across multiple informants: Parent Parent Teacher Teacher Self-report Self-report 3 age versions: 3 age versions: preschool (4 to 5 years) preschool (4 to 5 years) child (6 to 11 years) child (6 to 11 years) Adolescents (12 to 18 years) Adolescents (12 to 18 years)

ADHD Profile Mean T-Values on BASC Parent (PRS) Teacher (TRS) Hyperactivity Aggression Conduct Problem Anxiety Depression Attention Probs Learning Probs. n/a60.8 Atypicality Withdrawal

University Medical Center ADHD Clinic Assessment Battery: Parent interview Parent interview School questionnaire School questionnaire Parent and teacher rating scales: Parent and teacher rating scales: BASC BASC CSI-4 CSI-4 IQ screener: WASI IQ screener: WASI Achievement screener: WRAT-3 Achievement screener: WRAT-3 Physical Examination Physical Examination Case Study

Interventions Educational Accommodations Educational Accommodations Behavior Management Behavior Management Positive reinforcement Positive reinforcement Token economy Token economy Medication Management Medication Management 60-90% respond to medication 60-90% respond to medication See medication handout See medication handout