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Treating Attention Deficit Hyperactivity Disorder Assessment and Intervention in Developmental Context

Edited by Steven W. Evans, Ph.D. and Betsy Hoza, Ph.D.

4478 U.S. Route 27 • P.O. Box 585 • Kingston, NJ 08528

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Copyright © 2011

By Civic Research Institute, Inc. Kingston, New Jersey 08528

The information in this book is not intended to replace the services of professionals trained in psychiatry or other mental health care, social service advocacy, or any other discipline discussed in this book. Civic Research Institute, Inc. provides this informa- tion without advocating the use of or endorsing the issues, theories, precedent, guid- ance, resources, or practical materials discussed herein. Any application of the issues, theories, precedent, guidance, resources, or practical materials set forth in this book is at the reader’s sole discretion and risk. The authors, editors, and Civic Research Institute, Inc. specifically disclaim any liability, loss or risk, personal or otherwise, which is incurred as a consequence, directly or indirectly, of the use and application of any of the contents of this book.

All rights reserved. This book may not be reproduced in part or in whole by any proc- ess without written permission from the publisher.

This book is printed on acid free paper.

Printed in the United States of America

Library of Congress Cataloging in Publication Data Treating Attention Deficit Hyperactivity Disorder: Assessment and Intervention in Developmental Context / Steven W. Evans, Ph.D., and Betsy Hoza, Ph.D.

ISBN 978-1-887554-80-0

Library of Congress Control Number: 2011933123

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Table of Contents

About the Editors and Contributors ...... xxi

Part 1: Introduction to ADHD: Background and Biology

Chapter 1: Overview and Historical Background of Attention Deficit Hyperactivity Disorder by Kevin M. Antshel, Ph.D. and Russell Barkley, Ph.D. Introduction ...... 1-2 Early Descriptions of ADHD ...... 1-2 Alexander Crichton’s Description ...... 1-2 Fidgety Phillip ...... 1-3 George Still’s Description ...... 1-3 A. F. Tredgold’s Description ...... 1-4 The 1917–1918 Encephalitis Epidemic ...... 1-4 Associations Between Brain Disease and Behavioral Pathology ...... 1-5 Post-Encephalitic Behavior Disorder ...... 1-5 Frontal Lobe Lesions ...... 1-5 Brain Injury ...... 1-5 The Birth of Pediatric Psychopharmacology ...... 1-6 The Hyperkinetic Syndrome ...... 1-6 The 1970s ...... 1-7 Attention Deficits Become Central to ADHD ...... 1-7 Assessing Hyperactivity and Inattention ...... 1-8 Treatment ...... 1-9 Stimulant Medications ...... 1-9 Parenting ...... 1-9 Behavior Modification ...... 1-10 Public Law 94-142 ...... 1-10 Adult MBD/Hyperactivity ...... 1-10 The 1980s ...... 1-11 Research Diagnostic Criteria ...... 1-11 The Rise and Fall of Inattention ...... 1-12 ADD Subtyping ...... 1-13 Assessment ...... 1-13 Treatment ...... 1-14 Cognitive-Behavioral Therapy ...... 1-14 Parent Training ...... 1-14 Tricyclic Antidepressants ...... 1-14 The Emergence of Parent Support Associations ...... 1-15

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vi Treating Attention Deficit Hyperactivity Disorder

The 1990s ...... 1-15 Neuroimaging ...... 1-15 Genetics ...... 1-15 Research ...... 1-15 Twin Studies ...... 1-16 Molecular Techniques ...... 1-16 Adult ADHD ...... 1-16 DSM-IV ...... 1-16 Multimodal Treatment of ADHD (MTA) Study ...... 1-16 2000 and Beyond ...... 1-17 Neuroimaging ...... 1-17 Genetics ...... 1-17 Neuropsychology ...... 1-18 ADHD Subtyping ...... 1-18 Treatment ...... 1-18 Conclusion ...... 1-19

Chapter 2: Attention Deficit Hyperactivity Disorder, Catecholamines, and the “Default Mode” of Brain Function: A Reassessment of the Dopaminergic Hypothesis of ADHD by Francisco Aboitiz, Ph.D. and F. Xavier Castellanos, M.D. Introduction ...... 2-1 Catecholaminergic Signaling ...... 2-2 Modes of Dopaminergic Signaling and Goal-Directed Behavior ...... 2-4 Dopaminergic Signaling and ADHD Symptomatology ...... 2-5 Norepinephrine and Other Neurotransmitters ...... 2-7 Action of Stimulants (and Nonstimulants) ...... 2-7 The “Default Mode” Network and ADHD ...... 2-9 Does Impairment in “Default Mode” Regulation Relate to Alterations in Catecholaminergic Signaling? ...... 2-12 Conclusion ...... 2-13

Part 2: Assessment Issues and Techniques

Chapter 3: Assessment of Attention Deficit Hyperactivity Disorder in Young Children by Steve S. Lee, Ph.D. and Kathryn L. Humphreys, M.A., Ed.M. Introduction ...... 3-2 Phenomenology and Terminology ...... 3-3 ADHD Subtypes ...... 3-4 Comorbid Oppositionality and Aggression ...... 3-4 Epidemiology ...... 3-5 Age of Onset ...... 3-5 Prevalence ...... 3-5

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Table of Contents vii

Gender Influences ...... 3-6 Race-Ethnicity and Socioeconomic Status ...... 3-7 Is ADHD a Valid Disorder in Young Children? ...... 3-8 DSM-III-R Versus DSM-IV Symptoms ...... 3-8 Outcomes of Young Children With ADHD ...... 3-9 ADHD and Disruptive Behavior Disorders ...... 3-10 Additional ADHD Studies ...... 3-11 Assessment Instruments ...... 3-12 Diagnostic Interviews ...... 3-12 Respondent-Based Interviews ...... 3-12 Interviewer-Based Interviews ...... 3-13 Respondent-Based Interviews ...... 3-13 National Institute of Mental Health Diagnostic Interview Schedule for Children ...... 3-13 Diagnostic Interview Schedule, Young Children ...... 3-14 Interviewer-Based Interviews ...... 3-14 Kiddie Schedule for Affective Disorders-PL ...... 3-14 Preschool Age Psychiatric Assessment ...... 3-15 Preschool Attention Deficit Hyperactivity Disorder Treatment Study Diagnostic Interview ...... 3-16 Children’s Interview for Psychiatric Symptoms ...... 3-16 Rating Scales ...... 3-16 Early Child Inventory-4 ...... 3-17 ADHD Rating Scale-IV Preschool Version ...... 3-17 Revised Conners’ Parent and Teacher Rating Scales . . . . . 3-18 Child Behavior Checklist/1.5-5 and Caregiver-Teacher Report Form ...... 3-18 Early Childhood Attention Deficit Disorder Evaluation Scale ...... 3-19 ADHD Symptoms Rating Scale ...... 3-19 Disruptive Behavior Rating Scale–Parent Version ...... 3-20 Preschool and Kindergarten Behavior Scales, 2nd Edition ...... 3-20 Eyberg Child Behavior Inventory ...... 3-20 Developmental Perspectives ...... 3-20 Clinical Perspectives ...... 3-22 Future Research Directions ...... 3-23 Conclusion ...... 3-24 Chapter 4: Assessment of Children and Adolescents With Attention Deficit Hyperactivity Disorder by Gregory A. Fabiano, Ph.D. Introduction ...... 4-1 Current Conceptualization of ADHD ...... 4-2 Current ADHD Assessment Methods ...... 4-4 Assessment of ADHD Symptoms ...... 4-4 ADHD Rating Scales ...... 4-4 ADHD Diagnostic Interviews ...... 4-6

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viii Treating Attention Deficit Hyperactivity Disorder

Assessment of ADHD Impairment ...... 4-6 Impairment Rating Scales ...... 4-7 Impairment Interviews ...... 4-8 ADHD-Related Observations ...... 4-8 ADHD Assessments for Progress Monitoring ...... 4-8 ADHD Assessments for Treatment Outcome ...... 4-10 Developmental Considerations in Assessment ...... 4-11 Summary and Recommendations for ADHD Assessments ...... 4-12

Chapter 5: Assessment of Problems Comorbid With Attention Deficit Hyperactivity Disorder by Paul J. Rosen, Ph.D., Tanya E. Froehlich, M.D., Joshua M. Langberg, Ph.D. and Jeffery N. Epstein, Ph.D. Introduction ...... 5-2 Disruptive Behavior Disorders ...... 5-3 Prevalence and Effects of Comorbidity ...... 5-3 Shared and Differential Aspects ...... 5-3 Shared Aspects ...... 5-3 Differential Aspects ...... 5-4 Assessment and Differential Diagnosis ...... 5-4 Anxiety Disorders ...... 5-5 Prevalence and Effects of Comorbidity ...... 5-5 Shared and Differential Aspects ...... 5-6 Shared Aspects ...... 5-6 Differential Aspects ...... 5-6 Assessment and Differential Diagnosis ...... 5-6 Depressive Disorders ...... 5-7 Prevalence and Effects of Comorbidity ...... 5-7 Shared and Differential Aspects ...... 5-8 Shared Aspects ...... 5-8 Differential Aspects ...... 5-8 Assessment and Differential Diagnosis ...... 5-8 Bipolar Disorder ...... 5-9 Prevalence and Effects of Comorbidity ...... 5-9 Prevalence of PBD Among Children With ADHD ...... 5-10 Prevalence of ADHD Among Children With PBD ...... 5-10 Shared and Differential Aspects ...... 5-10 Shared Aspects ...... 5-10 Differential Aspects ...... 5-10 Assessment and Differential Diagnosis ...... 5-11 Learning Disabilities ...... 5-11 Prevalence and Effects of Comorbidity ...... 5-11 Shared and Differential Aspects and Symptoms ...... 5-12 Shared Aspects ...... 5-12

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Table of Contents ix

Differential Aspects ...... 5-13 Assessment and Differential Diagnosis ...... 5-13 Intellectual Disabilities ...... 5-14 Prevalence and Effects of Comorbidity ...... 5-14 Shared and Differential Aspects and Symptoms ...... 5-15 Shared Aspects ...... 5-15 Differential Aspects ...... 5-15 Assessment and Differential Diagnosis ...... 5-15 Autism Spectrum Disorders ...... 5-15 Prevalence and Effects of Comorbidity ...... 5-15 Shared and Differential Aspects and Symptoms ...... 5-16 Shared Aspects ...... 5-16 Differential Aspects ...... 5-17 Assessment and Differential Diagnosis ...... 5-18 Conclusion ...... 5-19 Chapter 6: Neuropsychology of Attention Deficit Hyperactivity Disorder: Implications for Assessment and Treatment by Erik G. Willcutt, Ph.D. and L. Cinnamon Bidwell, Ph.D. Introduction ...... 6-2 Understanding the Neuropsychology of ADHD ...... 6-2 Competing Neuropsychological Models of ADHD ...... 6-3 Criteria 1 and 2: ADHD Group Deficits on Neuropsychological Measures Using Meta-Analysis to Summarize the Neuropsychological Literature on ADHD ...... 6-3 Executive Functions ...... 6-4 Motivational Dysfunction ...... 6-6 Delay Aversion Model ...... 6-6 Response Variability Model ...... 6-7 Processing Speed Model ...... 6-7 Conclusions Regarding Criteria 1 and 2 for a Primary Neuropsychological Deficit ...... 6-8 Criteria 3 and 4: Sensitivity and Specificity of Neuropsychological Weaknesses to ADHD ...... 6-8 Sensitivity ...... 6-8 Specificity to ADHD ...... 6-9 Potential Explanations for the Absence of a Single Primary Deficit in ADHD ...... 6-10 Measurement Weaknesses ...... 6-10 Diagnostic Heterogeneity ...... 6-11 DSM-IV Symptom Dimensions ...... 6-11 DSM-IV Subtypes...... 6-13 Conclusions Regarding Single-Deficit Neuropsychological Models of ADHD ...... 6-13

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x Treating Attention Deficit Hyperactivity Disorder

Implications for Clinical Assessment and Treatment ...... 6-15 Screening for Individuals at Risk for ADHD ...... 6-16 Identification of Targets for Intervention ...... 6-16 Physiological Mechanisms of Medication ...... 6-16 Future Directions ...... 6-17 Prediction of Later Developmental Outcomes ...... 6-17 Multidisciplinary Studies ...... 6-17 Etiologically Informative Designs and Endophenotypes . . . . 6-17 Brain Imaging ...... 6-17 Conclusion ...... 6-18

Chapter 7: Assessing Treatment Response by Arthur D. Anastopoulos, Ph.D. and Terri L. Shelton, Ph.D. Introduction ...... 7-2 ADHD Overview ...... 7-2 Situational Variability ...... 7-3 Psychosocial Difficulties ...... 7-3 Comorbidity ...... 7-3 Clinical Presentations ...... 7-4 Eight-Step Outcome Evaluation Process ...... 7-4 Step 1—Determining Outcomes ...... 7-6 Intervention Target ...... 7-6 Behaviors to Target for Treatment ...... 7-6 Symptoms Versus Functional Impairments ...... 7-7 Treatment of Comorbid Conditions ...... 7-7 Treatment Response ...... 7-7 Outcome Indicators ...... 7-8 Step 2—Determining Criteria for Success ...... 7-8 Intervention Criteria ...... 7-9 Meaningful Change ...... 7-9 Intervention Success ...... 7-10 Step 3—Selecting Methods of Evaluation ...... 7-10 Outcome Indicators ...... 7-10 Evaluation Process ...... 7-11 Timing Considerations ...... 7-11 Multimethod Approach ...... 7-11 Step 4—Collecting Baseline Data ...... 7-12 Step 5—Determining the Integrity of the Intervention ...... 7-12 Intervention Integrity Checklist ...... 7-13 Improvement Assessment ...... 7-14 Step 6—Measuring Outcomes ...... 7-15 Data Collection ...... 7-15 Treatment Evaluation ...... 7-15 Outcome Evaluation ...... 7-15 Step 7—Determining Efficacy of Treatment and Costs/Benefits Analysis ...... 7-16

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Table of Contents xi

Treatment Side Effects ...... 7-16 School-Based Interventions ...... 7-16 Step 8—Continuing, Modifying, or Replacing Treatment ...... 7-17 Conclusion ...... 7-17

Part 3: Treatment Approaches Chapter 8: Pharmacological Interventions for Individuals With Attention Deficit Hyperactivity Disorder by Mark L. Wolraich, M.D. Introduction ...... 8-2 Dextroamphetamine ...... 8-2 Methylphenidate ...... 8-3 Stimulant Preparations ...... 8-3 Young Children ...... 8-4 Adolescents ...... 8-4 Response Rates ...... 8-4 Methylphenidate ...... 8-5 Abuse and Diversion ...... 8-6 Drug Interactions ...... 8-6 Long-Term Effects ...... 8-6 Sudden Cardiac Death ...... 8-7 Amphetamines ...... 8-7 Combined Treatments ...... 8-8 Nonstimulant FDA Approved Medications for ADHD ...... 8-10 Atomoxetine ...... 8-10 Alpha Adrenergic Agents ...... 8-10 Cost ...... 8-11 Medications Used Clinically for ADHD But Not FDA Approved ...... 8-11 Tricyclic Antidepressants ...... 8-13 Buproprion ...... 8-14 Modafanil ...... 8-14 Conclusion ...... 8-14

Chapter 9: Psychosocial Treatments for Preschoolers At-Risk for Attention Deficit Hyperactivity Disorder by Amanda P. Williford, Ph.D. and Terri L. Shelton , Ph.D. Introduction ...... 9-2 Parent-Focused Interventions ...... 9-3 Features ...... 9-4 Parent-Child Relationship ...... 9-4 Coercion Theory ...... 9-4 Parent Training Programs ...... 9-5 Preschoolers’ Entry into Formal Schooling ...... 9-7

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xii Treating Attention Deficit Hyperactivity Disorder

Parent-Child Interaction Therapy ...... 9-7 Varying Components ...... 9-8 Effectiveness ...... 9-8 Child-Focused Interventions ...... 9-9 Peer Rejection ...... 9-9 Group-Based Social Skills Programs ...... 9-9 Child Training ...... 9-10 Incredible Years ...... 9-10 Promoting Alternative Thinking Strategies ...... 9-10 Emotion-Based Prevention Program ...... 9-11 Other Curricular Programs ...... 9-11 Summary ...... 9-11 Teacher-Focused Interventions ...... 9-12 Group-Based Teacher Training ...... 9-13 Implementation of Teacher-Focused Intervention Through Mental Health Consultation ...... 9-13 Multimodal Approaches ...... 9-14 Incredible Years Program ...... 9-14 Chicago School Readiness Project ...... 9-15 Conclusion ...... 9-16

Chapter 10: Psychosocial Interventions for Elementary School-Aged Children With Attention Deficit Hyperactivity Disorder by Julie Sarno Owens, Ph.D., Jennifer L. Storer, M.S. and Erin Girio-Herrera, Ph.D. Introduction ...... 10-2 Background ...... 10-3 Theoretical Overview ...... 10-3 Behavioral Parenting Programs ...... 10-4 Description ...... 10-4 Empirical Support ...... 10-5 New Directions ...... 10-7 Single Mothers ...... 10-7 Fathers ...... 10-8 Low-Income Minority Families ...... 10-8 Matching Treatment to Parent Preferences ...... 10-9 Mothers With Depression ...... 10-10 Behavioral Classroom Interventions ...... 10-11 Description ...... 10-11 Empirical Support ...... 10-13 Proactive Strategies ...... 10-13 Token Economy Programs ...... 10-13 Response-Cost Programs ...... 10-13 Daily Report Card (DRC) ...... 10-14 Promising Interventions ...... 10-14

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Table of Contents xiii

New Directions ...... 10-15 Feasibility of the DRC Intervention ...... 10-15 Mechanisms for Intervention Adoption ...... 10-16 School Mental Health Services With Underserved Populations ...... 10-16 Intensive Summer Treatment Programs ...... 10-17 Description ...... 10-17 Empirical Support ...... 10-18 New Directions ...... 10-20 Combined Treatments ...... 10-21 Description and Background ...... 10-21 Empirical Support ...... 10-21 MTA Study Description ...... 10-21 MTA Fourteen-Month Outcomes ...... 10-22 Assessing Long-Term Outcomes ...... 10-23 New Directions ...... 10-25 Dose of Treatment ...... 10-25 Optimal Treatment Sequence ...... 10-26 New Directions in Assessing Treatment Outcome ...... 10-26

Chapter 11: Psychosocial Interventions for Adolescents With Attention Deficit Hyperactivity Disorder by Joanna M. Sadler, M.A. and Steven W. Evans, Ph.D. Introduction ...... 11-1 Adolescence and ADHD ...... 11-2 Developmental Changes ...... 11-2 Relationships ...... 11-2 Adolescents at Risk ...... 11-3 Adolescent Costs ...... 11-3 Treatment ...... 11-3 Areas of Functioning and Associated Interventions ...... 11-4 Academic Functioning ...... 11-4 Academic Interventions ...... 11-4 Self-Management ...... 11-5 Organization ...... 11-5 Note-taking ...... 11-6 Homework Management ...... 11-7 Teacher Consultation ...... 11-8 Social Functioning ...... 11-9 Social Interventions ...... 11-9 Family Functioning ...... 11-11 Family Interventions ...... 11-12 Multicomponent Interventions ...... 11-13 Conclusion ...... 11-16

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xiv Treating Attention Deficit Hyperactivity Disorder

Chapter 12: Psychosocial Treatment of Adults With Attention Deficit Hyperactivity Disorder by Laura E. Knouse, Ph.D. and Steven A. Safren, Ph.D. Introduction ...... 12-2 Reasons for Psychosocial Treatment for Adults With ADHD ...... 12-2 Psychosocial Treatments Supported by Scientific Evidence ...... 12-3 Comprehensive Assessment ...... 12-3 Psychotherapies Without Empirical Support for Adults With ADHD . . 12-5 Psychosocial Treatments With Emerging Empirical Support . . . . . 12-5 Individual Treatments ...... 12-5 Group Treatments ...... 12-6 Summary of Findings, Limitations, and Future Directions ...... 12-8 Recommended Practices in Psychosocial Treatment of Adults With ADHD . . 12-10 Conduct a Thorough Diagnostic Assessment ...... 12-10 Choose a Few Clear and Salient Treatment Goals ...... 12-10 Focus on Compensatory Skills ...... 12-11 Develop a Structured Format ...... 12-11 Maintain a Collaborative and Transparent Working Relationship . . . 12-11 Assess Symptoms Throughout Treatment ...... 12-12 Provide Appropriate Psychoeducation ...... 12-12 Attend to Medication Adherence ...... 12-12 Practice, Reinforce, and Repeat ...... 12-13 Attend to Thoughts and Feelings That Block Skill Use ...... 12-13 Watch for Overly Positive Thinking ...... 12-13 Restructure the Environment ...... 12-13 Be Creative, But Keep it Simple ...... 12-14 Consider the Length and Frequency of Treatment ...... 12-14 Consider Referral for Other Services ...... 12-14 Psychosocial Treatment of Comorbid Disorders in Adults With ADHD ...... 12-14 Conclusion ...... 12-17

Chapter 13: Integrating Pharmacological and Psychosocial Interventions for Attention Deficit Hyperactivity Disorder: An Evidence-Based, Participatory Approach by Thomas J. Power, Ph.D., Stephen L. Soffer, Ph.D., Michael C. Cassano, Ph.D., Katy E. Tresco, Ph.D. and Jennifer A. Mautone, Ph.D. Introduction ...... 13-2 Separate Versus Integrated Approaches to Intervention ...... 13-3 Findings ...... 13-4 Subsequent Analyses ...... 13-4 Follow-up Analyses ...... 13-4 Staging and Dosing Integrated Treatments for ADHD ...... 13-5 Example Protocols ...... 13-6

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Table of Contents xv

Combination Treatment ...... 13-6 Behavior Therapy ...... 13-6 Implications ...... 13-7 Developing Treatment Plans in Response to Family Preferences and Beliefs . . 13-7 Model of Help-Seeking Behavior for ADHD ...... 13-7 Problem Recognition Stage ...... 13-8 Decision to Seek Help Stage ...... 13-8 Service Selection Stage ...... 13-8 Service Utilization Stage ...... 13-8 Model Summary ...... 13-9 Strategies to Improve Service Utilization ...... 13-9 Building the Capacity of Community-Based Systems . . . . . 13-9 Promoting Participant Engagement ...... 13-10 Reducing Barriers to Service Delivery ...... 13-10 Integrating Treatments: A Participatory, Evidence-Based Approach . . . . . 13-11 Assess Beliefs, Barriers, and Resources in Multiple Systems of Care . . 13-11 Identify Treatments That are Rooted in Evidence ...... 13-12 Employ a Participatory Model to Develop and Refine Intervention Plans ...... 13-13 Use a Staged Approach That Systematically Varies Treatment Type and Dosage ...... 13-13 Use a Multimethod Assessment Battery to Assess Process and Outcome Variables ...... 13-13 Conclusion ...... 13-15

Chapter 14: Ingestible Alternative and Complementary Treatments for Attention Deficit Hyperactivity Disorder by L. Eugene Arnold, M.Ed., M.D., Elizabeth Hurt, Ph.D., Tara Mayes, M.D. and Nicholas Lofthouse, Ph.D. Introduction ...... 14-2 SECS (Safe, Easy, Cheap, and Sensible) Versus RUDE (Risky, Unrealistic, Difficult, or Expensive) Criterion ...... 14-3 Elimination Diets (Oligoantigenic, Few-Foods, or Defined Diets) ...... 14-4 Nutritional Supplements ...... 14-8 Amino Acid Supplementation ...... 14-8 Essential Fatty Acid Supplementation ...... 14-8 L-Carnitine ...... 14-13 Glyconutritional Supplements ...... 14-14 Dimethylaminoethanol ...... 14-14 Vitamin Supplementation ...... 14-15 RDA/RDI Multivitamin Preparations ...... 14-15 Megavitamin Multiple Combinations ...... 14-15 Megadoses of Specific Vitamins ...... 14-16

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xvi Treating Attention Deficit Hyperactivity Disorder

Mineral Supplements ...... 14-16 Iron Supplementation ...... 14-16 Zinc Supplementation ...... 14-17 Magnesium Supplementation ...... 14-18 Combination of Supplements ...... 14-19 Herbal, Homeopathic, and Naturopathic Treatments ...... 14-19 Herbs ...... 14-19 Pycnogenol ...... 14-20 Ginkgo Biloba ...... 14-20 Combination of Gingko Biloba and Ginseng ...... 14-20 St. John’s Wort ...... 14-20 Melatonin ...... 14-21 Herbs in Use Without ADHD Evidence But With Risk ...... 14-21 Homeopathic Remedies ...... 14-22 Antifungal Treatment ...... 14-23 Thyroid Treatment ...... 14-23 Deleading ...... 14-24 Combination of Ingestible Treatments ...... 14-25 Recommendations for Clinical Practice ...... 14-25 Approach to Selecting Treatment ...... 14-28 Recommendations for Future Research ...... 14-28

Chapter 15: Noningestible Alternative and Complementary Treatments for Attention Deficit Hyperactivity Disorder by Elizabeth A. Hurt, Ph.D., Nicholas Lofthouse, Ph.D., and L. Eugene Arnold, M.D. Background and Definitions of Complementary and Alternative Treatments ...... 15-2 Section 1: Treatments With Some Evidence ...... 15-3 Neurofeedback ...... 15-3 Electromyographic Biofeedback, Relaxation Training, and Hypnosis ...... 15-6 Meditation ...... 15-7 Yoga ...... 15-9 Massage Therapy ...... 15-10 Vestibular Stimulation ...... 15-11 Working Memory Training ...... 15-12 Attention Training ...... 15-14 Section 2: Emerging Research ...... 15-14 Sensory Interventions ...... 15-15 Interactive Metronome Training ...... 15-15

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Occupational Therapy and Treatment Components . . . . . 15-15 Treatments for Learning Disabilities and ADHD Symptoms ...... 15-16 Other Treatments With Poor Evidence ...... 15-18 Acupuncture ...... 15-18 Mirror Feedback ...... 15-18 Immune Therapy ...... 15-18 Conclusion ...... 15-19

Part 4: ADHD in Context

Chapter 16: Attention Deficit Hyperactivity Disorder: School Navigation and Functioning by Allison H. Cloth, Ph.D. and Brandon K. Schultz, Ed.D., NCSP Introduction ...... 16-1 ADHD and Functional Impairments ...... 16-2 Academic Impairment ...... 16-2 Social Impairment ...... 16-3 Eligibility for School-Based Services ...... 16-3 Assessment of ADHD ...... 16-4 Special Education ...... 16-5 Section 504 ...... 16-7 Accommodations ...... 16-8 Evidence-Based Interventions ...... 16-9 Educational Rights ...... 16-10 School Discipline Practices ...... 16-10 Transitioning ...... 16-11 Conclusion ...... 16-11 Improving Service Delivery, Accessibility, and Use ...... 16-12 Future Directions ...... 16-12

Chapter 17: Family Functioning By Charlotte Johnston, Ph.D. and Sharon C. Lee-Flynn, Ph.D. Introduction ...... 17-1 Defining Family Functioning and the Scope of Our Review ...... 17-2 Developmental Model ...... 17-2 Parent-Child Relationships in Families of Children With ADHD ...... 17-3 Longitudinal Studies Linking Parenting and Child ADHD Symptoms ...... 17-4 Preschool Years—Parent-Child Interactions ...... 17-4 Elementary School-Age Years ...... 17-5

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xviii Treating Attention Deficit Hyperactivity Disorder

Parent-Child Interactions ...... 17-5 Parenting Cognitions ...... 17-7 Adolescence ...... 17-8 Summary ...... 17-8 Parent-Child Relationships in Families of Parents Who Have ADHD . . . . . 17-9 When the Parent Has ADHD ...... 17-9 Parent-Child Interactions ...... 17-9 Cognitions ...... 17-10 Comorbidities in Parents With ADHD ...... 17-11 When Parent and Child Both Have ADHD ...... 17-11 Parent-Child Interactions ...... 17-11 Effects on Treatment ...... 17-14 Sibling Relationships in Families of Children With ADHD ...... 17-15 Marital Relationships in ADHD Families ...... 17-16 Relationships Between Adults With ADHD and Their Spouses ...... 17-16 Relationship Between Parents of a Child With ADHD ...... 17-16 Summary and Future Directions ...... 17-17 Conclusion ...... 17-19

Chapter 18: Attention Deficit Hyperactivity Disorder and Peer Interactions by Meghan Tomb, B.A., Kate Linnea, B.A., Julia D. McQuade, B.A. and Betsy Hoza, Ph.D. Introduction ...... 18-1 Behavior and Peer Relationships ...... 18-2 ADHD and Social Behaviors ...... 18-2 Linking Behavior to Peer Rejection ...... 18-3 Subtypes and Social Impairment ...... 18-4 Peer Interactions Across Developmental Periods ...... 18-6 Implications of Social Impairment Over Time ...... 18-8 Additional Contributors to Social Impairment ...... 18-9 ADHD and Bias of Self-Perceptions of Social Competence ...... 18-9 Cognitive Deficits ...... 18-11 Social Information Processing ...... 18-12 Treatment of Social Problems: What Can We Do to Break the Cycle? . . . . 18-13 Stimulant Medication and Behavioral Management to Treat Social Impairment ...... 18-13 Social Skills Interventions and Social Impairment ...... 18-15 Social Interventions for Adolescents ...... 18-16 Social Interventions for Different ADHD Subtypes ...... 18-16 Additional Considerations for Social Interventions ...... 18-17 Conclusion ...... 18-18

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Chapter 19: Delinquency and Substance Use in Attention Deficit Hyperactivity Disorder: Adolescent and Young Adult Outcomes in Developmental Context by Brooke S. G. Molina, Ph.D. Introduction ...... 19-2 Delinquency ...... 19-2 Antisociality Course as it Relates to ADHD ...... 19-3 Antisocial Outcomes Variously Defined ...... 19-4 Conduct Disorder in Adolescence ...... 19-4 Arrest Rates in Adolescence ...... 19-14 Delinquency in Adolescence ...... 19-15 Antisocial Personality Disorder in Adulthood ...... 19-16 Arrest Rates and Delinquency in Early Adulthood . . . . . 19-17 Summary ...... 19-18 Use, Abuse, and Dependence on Alcohol, Tobacco, and Other Drugs ...... 19-18 Risk Factors ...... 19-18 Childhood Behavior ...... 19-19 Etiologic Pathways ...... 19-19 Potential Mediators of ADHD Risk for Substance Use, Abuse, and Dependence in ADHD ...... 19-20 The Role of CD in ADHD Risk for Substance Use ...... 19-21 Developmental Trends in Alcohol Use and Abuse/Dependence . . . . 19-22 Alcohol Outcomes in Adolescence ...... 19-23 Alcohol Outcomes in Early Adulthood ...... 19-26 Summary ...... 19-29 Tobacco ...... 19-29 Cigarette Smoking in Adolescence and Young Adulthood ...... 19-30 Marijuana and Other Illicit Drug Use...... 19-34 Developmental Trends ...... 19-34 Marijuana Outcomes in Adolescence ...... 19-35 Marijuana Outcomes in Early Adulthood ...... 19-38 Use and Abuse of Other Illicit Drugs ...... 19-39 Summary ...... 19-39 Does Medication Treatment Predispose or Protect Children With ADHD From Later Substance Use/Substance Use Disorder? . . . . 19-40 Summary and Conclusion ...... 19-42

Chapter 20: Assessing and Treating Attention Deficit Hyperactivity Disorder in Culturally Diverse Populations by Regina Bussing, M.D., M.S.H.S., FAPA and Faye Gary, Ed.D., R.N., FAAN Race, Ethnicity, and Culture—Caution and Context ...... 20-2 Introduction ...... 20-2 Race ...... 20-3

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xx Treating Attention Deficit Hyperactivity Disorder

Ethnicity ...... 20-4 Culture ...... 20-4 Prejudice and Discrimination ...... 20-4 Minority Groups ...... 20-5 Patient-Centered Care and Cultural Competency ...... 20-5 Ethical Consideration in Cultural Context ...... 20-6 Racial/Ethnic Variation in ADHD Prevalence and Symptomatology . . . . . 20-6 National Survey Prevalence Estimates ...... 20-8 Racial/Ethnic Variations in Teacher ADHD Symptom Ratings . . . . 20-9 From Prevalence to Treatment: Mediators of Help-Seeking for ADHD . . . . 20-10 ADHD Knowledge ...... 20-10 Qualitative Research on Variations in Explanatory Models of ADHD ...... 20-12 Qualitative Studies Focused on Latino Families ...... 20-12 Qualitative and Mixed Methods Research Focused on African-American Families ...... 20-13 Stigma Perceptions ...... 20-15 When Families Seek Help: Providing Culturally Appropriate ADHD Treatment ...... 20-16 Cultural Variations in ADHD Treatments and Outcomes ...... 20-16 Treatment Adaptations, Tailoring, and Evidence-Based Practice ...... 20-18 Future Directions and Recommendations ...... 20-19

Index ...... I-1

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