<p> ▸ Outline Chapter 22 Attention Deficits and Hyperactivity</p><p>▸ ADD/ADHD is one of the most prevalent neurodevelopmental mental health conditions in childhood</p><p>▸ Developmentally inappropriate levels of inattention, distractability, and/or hyperactivity</p><p>▸ Impaired adaptive functioning at home, school, in social settings</p><p>▸ Diagnosis and assessment consists of looking for symptoms of ADHD and “ruling out” other causes</p><p>▸ Two clusters of symptoms: inattention (ADD) and hyperactivity/impulsivity (ADHD</p><p>▸ ADHD is:</p><p>◦ Evident before age 7</p><p>◦ Persists for more than 6 months</p><p>◦ Occurs across multiple settings</p><p>◦ Causes educational impairment</p><p>◦ Unaccounted for by another disorder</p><p>▸ Prevalent in 7%–10% of U.S. children and in 5% worldwide</p><p>▸ Persists into adulthood in 2%–5% of U.S. population</p><p>▸ Ratio of boys to girls: 6:1 to 12:1</p><p>▸ Boys are referred more due to aggressive behavior, oppositional and conduct disorders</p><p>▸ Girls are referred for inattentive subtype, associate learning and internalizing disorders, including eating disorders</p><p>Symptoms: </p><p>◦ excessive activity level and impulsivity, </p><p>◦ “intense” temperament and aggression toward peers</p><p>◦ greater rate of developmental delay, </p><p>◦ coordination disorders, ◦ language disorders,</p><p>◦ mood and anxiety disorders</p><p>◦ Lack of listening and compliance, </p><p>◦ Lack of task completion, </p><p>◦ Inaccurate work, </p><p>◦ Socialization problems</p><p>◦ Some children not diagnosed until adolescence</p><p>▸ There are many coexisting conditions:</p><p>◦ Oppositional defiant disorder, conduct disorder</p><p>◦ Bipolar disorder: 11%–23%</p><p>◦ Anxiety disorders: 15%–35%</p><p>◦ Learning disorders: 10%–40%</p><p>◦ Tic disorders: 6%</p><p>▸ Affects Executive functioning—cannot sustain attention and shifts constantly, decrease of working memory, lack of organization, and lack of self-monitoring</p><p>▸ Affects Academic Performance—low verbal memory, low listening comprehension, lack of organization in verbal and written output, delay in language</p><p>▸ Social and adaptive disorder— inability to “read” nuances of social behavior, impulsive responses, socially inappropriate language</p><p>▸ Inconsistent Sleep patterns— affects daytime alertness, decreased rapid eye movement, increased nighttime activity</p><p>▸ Lack of Motor coordination—motor problems that impair written work and academics, as well as athletic activities</p><p>▸ Genetics</p><p>◦ Most common etiological factor</p><p>◦ Siblings 5–7 times more likely to have ADHD; child of parent with ADHD, 25% chance</p><p>◦ Multiple genes are candidates for susceptibility to ADHD ◦ Prenatal exposure to cigarettes, lead, alcohol, drugs</p><p>◦ Intrauterine growth retardation, brain infections, prematurity</p><p>◦ Low cerebral blood flow</p><p>◦ Prematurity, low birth weight</p><p>▸ There are structural and functional differences in the brain (shape, thickness, and volume of five regions)</p><p>▸ Brain/neurological examinations include MRI, fMRI, PET, SPECT Evaluation Process</p><p>▸ Assessment includes four areas:</p><p>◦ Symptoms of ADHD</p><p>◦ Conditions that might cause same symptoms</p><p>◦ Coexisting conditions</p><p>◦ Associated medical, psychosocial, learning issues </p><p>▸ Assessments are:</p><p>◦ Comprehensive history</p><p>◦ Physical/neurological exam</p><p>◦ Academic assessment Treatments for Attention-Deficit/ Hyperactivity Disorder </p><p>▸ Education—information and connection to support and advocacy groups</p><p>▸ 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</p><p>▸ Educational treatment— substantial repetition or alternate methods of instruction, environmental modifications and behavior management techniques, special education </p><p>▸ Medication</p><p> Most effective and most common</p><p> Reduce symptoms in 70%–90% of children  Must be carefully monitored for downsides, such as side effects and later substance abuse</p><p> Alternative Therapies</p><p>▸ Some evidence for effectiveness, but more studies needed</p><p>▸ Elimination diets: elimination of additives, allergenic foods, sugar</p><p>▸ Nutrient supplementation: Iron, zinc, magnesium as well as multinutrients and essential fatty acids</p><p>▸ Brain training techniques: Electroencephalogram (EEG) biofeedback Outcomes</p><p>• ADHD symptoms decline over time, but functional impairments can persist into young adulthood</p><p>• ADHD youth are at higher risk for coexisting conditions such as antisocial, mood, anxiety, eating disorders</p><p>• Conduct disorders can predict more severe outcome risks (failure to graduate, early sexual activity and parenthood, substance abuse)</p><p>• Behavioral treatment particularly important in subgroups with coexisting symptoms and psychosocial adversity</p>