ADD/ADHD Is One of the Most Prevalent Neurodevelopmental Mental Health Conditions in Childhood

▸ Outline Chapter 22 Attention Deficits and Hyperactivity

▸ ADD/ADHD is one of the most prevalent neurodevelopmental mental health conditions in childhood

▸ Developmentally inappropriate levels of inattention, distractability, and/or hyperactivity

▸ Impaired adaptive functioning at home, school, in social settings

▸ Diagnosis and assessment consists of looking for symptoms of ADHD and “ruling out” other causes

▸ Two clusters of symptoms: inattention (ADD) and hyperactivity/impulsivity (ADHD

▸ ADHD is:

◦ Evident before age 7

◦ Persists for more than 6 months

◦ Occurs across multiple settings

◦ Causes educational impairment

◦ Unaccounted for by another disorder

▸ Prevalent in 7%–10% of U.S. children and in 5% worldwide

▸ Persists into adulthood in 2%–5% of U.S. population

▸ Ratio of boys to girls: 6:1 to 12:1

▸ Boys are referred more due to aggressive behavior, oppositional and conduct disorders

▸ Girls are referred for inattentive subtype, associate learning and internalizing disorders, including eating disorders

Symptoms:

◦ excessive activity level and impulsivity,

◦ “intense” temperament and aggression toward peers

◦ greater rate of developmental delay,

◦ coordination disorders, ◦ language disorders,

◦ mood and anxiety disorders

◦ Lack of listening and compliance,

◦ Lack of task completion,

◦ Inaccurate work,

◦ Socialization problems

◦ Some children not diagnosed until adolescence

▸ There are many coexisting conditions:

◦ Oppositional defiant disorder, conduct disorder

◦ Bipolar disorder: 11%–23%

◦ Anxiety disorders: 15%–35%

◦ Learning disorders: 10%–40%

◦ Tic disorders: 6%

▸ Affects Executive functioning—cannot sustain attention and shifts constantly, decrease of working memory, lack of organization, and lack of self-monitoring

▸ Affects Academic Performance—low verbal memory, low listening comprehension, lack of organization in verbal and written output, delay in language

▸ Social and adaptive disorder— inability to “read” nuances of social behavior, impulsive responses, socially inappropriate language

▸ Inconsistent Sleep patterns— affects daytime alertness, decreased rapid eye movement, increased nighttime activity

▸ Lack of Motor coordination—motor problems that impair written work and academics, as well as athletic activities

▸ Genetics

◦ Most common etiological factor

◦ Siblings 5–7 times more likely to have ADHD; child of parent with ADHD, 25% chance

◦ Multiple genes are candidates for susceptibility to ADHD ◦ Prenatal exposure to cigarettes, lead, alcohol, drugs

◦ Intrauterine growth retardation, brain infections, prematurity

◦ Low cerebral blood flow

◦ Prematurity, low birth weight

▸ There are structural and functional differences in the brain (shape, thickness, and volume of five regions)

▸ Brain/neurological examinations include MRI, fMRI, PET, SPECT Evaluation Process

▸ Assessment includes four areas:

◦ Symptoms of ADHD

◦ Conditions that might cause same symptoms

◦ Coexisting conditions

◦ Associated medical, psychosocial, learning issues

▸ Assessments are:

◦ Comprehensive history

◦ Physical/neurological exam

◦ Academic assessment Treatments for Attention-Deficit/ Hyperactivity Disorder

▸ Education—information and connection to support and advocacy groups

▸ Behavioral counseling and social skill intervention—can include individual or group sessions, parent training, classroom management programs, social skill-building, emotional support, cognitive behavioral therapy, coaching

▸ Educational treatment— substantial repetition or alternate methods of instruction, environmental modifications and behavior management techniques, special education

▸ Medication

 Most effective and most common

 Reduce symptoms in 70%–90% of children  Must be carefully monitored for downsides, such as side effects and later substance abuse

 Alternative Therapies

▸ Some evidence for effectiveness, but more studies needed

▸ Elimination diets: elimination of additives, allergenic foods, sugar

▸ Nutrient supplementation: Iron, zinc, magnesium as well as multinutrients and essential fatty acids

▸ Brain training techniques: Electroencephalogram (EEG) biofeedback Outcomes

• ADHD symptoms decline over time, but functional impairments can persist into young adulthood

• ADHD youth are at higher risk for coexisting conditions such as antisocial, mood, anxiety, eating disorders

• Conduct disorders can predict more severe outcome risks (failure to graduate, early sexual activity and parenthood, substance abuse)

• Behavioral treatment particularly important in subgroups with coexisting symptoms and psychosocial adversity