ADHD

Question 1

Prevalence

Answer 1

3 to 9%

Question 2

Age of onset

Answer 2

before 7

Question 3

Core symptoms

Answer 3

inattention and hyperactivity/impulsivity

Question 4

Requirement for diagnosis

Answer 4

1. symptoms 2. age of onset 3. impact on major life actives, 4 different environments 5. exclusions: deafness, blindness, language delay, depression, autism, psychosis

Question 5

Early vs. Late onset

Answer 5

chronicity vs. related to depression/anxiety

Question 6

Life course

Answer 6

40-80% will continue to have ADHD through adolescence…36% through adulthood

Question 7

Comorbid conditions

Answer 7

ODD/CD, depression, OCD
80% have another condition/60% have two conditions
-30-40% LD

Question 8

Base rate in clinical settings

Answer 8

50% referred to child mental health settings have ADHD

Question 9

Gender differences

Answer 9

9 boys to 1 girl ratio. Girls have less externalizing behaviors, but more internalizing and intellectual problems (masking effect on ADHD symptoms)

Question 10

Situational and contextual factors

Answer 10

1. symptoms more noticeable 2. mothers notice symptoms more 3. deviant behavior increases with familiarity 4. fatigue and time of day have impact 5. worse in group setting. 6. best performance in morning

Question 11

Impairments

Answer 11

1. medical, developmental, adaptive,behavioral, emotional, academic difficulties than their healthy peers
2. minor physical abnormalities
3. less socially involved
4. cognitive and psychomotor difficulties

Question 12

Etiology

Answer 12

Mostly neurological 
1. EF deficits 
2. blood flow to prefrontal regions
3. less brain volume right frontal region
4. smaller cerebellum
Genetics
1. family and twin studies (risk 40-57%
2. twin studies .70 to .97 degree of heritability (little to no effect of shared environment)
Toxins - tobacco, lead, alcohol (small)

Question 13

Outcomes

Answer 13

poor school performance, ODD and CD, Low intelligence/peer acceptance, emotional instability

Question 14

Conceptualization of the disorder

Answer 14

Barkley’s behavioral inhibition (4 EFS)

1. nonverbal working memory (covert self directed sensing)
2. verbal working memory (internalized, self-directed speech)
3. Self-regulation of affect-motivation-arousal (self-directed emotion)
4. Planning or reconstitution

Question 15

Assessment Considerations

Answer 15

1. more weight to parent and teacher
2. multiple observation
3. no gold standards
4. self report not reliable
5. structured interviewing with a parent is a minimum condition for an adequate assessment
6. look for comorbidity
7. assess strengths and weaknesses for treatment planning

Question 16

Parent ratings

Answer 16

• Behavior assessment system for children (better than CBCL because of adaptive functioning scales (more accurate; ostrander 1997)
• Home situational questionnaire (HSQ) measures the situational pervasiveness
• Conners Global Index (CGI) and Children’s Impairment Rating Scale (CIRS) good for progress monitoring and impairment
• Vineland – doesn’t add much over CIRS, however
• Checklist of DSM-IV symptoms using the Disruptive Behavior Disorders Scale
• screen parent for ADHD (high heritability)

The Conners’ Rating Scale - Revised demonstrates effective ADHD diagnostic utility, with sensitivity ranging between 92 and 100% and specificity ranging between 82 and 98%.[33] The Conners’ Rating Scales also include a self-report version which can be a useful addition to the assessment battery when the patient is an adolescent.

Question 17

Minimum requirements for evaluation

Answer 17

1. parent ratings of ADHD, other psychiatric disorders, and related impairments
2. teacher ratings of ADHD symptoms and functioning at school
3. a semistructured interview with a parent to ascertain influences on behavior
4. exam by a physician to rule out phsycial causes

Question 18

Teacher Ratings

Answer 18

1. TRS from the BASC
2. Disruputive Behavior Disorders Checklist (DBD)
3. School Situations Questionanire (SSQ)
4. Conners Global Index (CGI)
5. Children’s Impairment Rating Scale (CIRS)

Question 19

ADHD Checkup

Answer 19

1. Telephone contact prior to first session
2. Semistructured interview to evaluate interpersonal functioning, major presenting problems, developmental history, or other background variables
3. videotaped interactions between family members and child
4. Collaborative feedback with the parents regarding diagnosis and treatment recommendations

Question 20

Treatments

Answer 20

1. stimulants (methylphenidate, amphetamines)
   e.g. ritalin, conerta
   10-25% of children do not benefit
2. Parent training
3. Classroom interventions
   - cooperative learning (not individual work)
   - positive reinforcement and response cost is optimal
   - dead man’s rule (if a dead man can do it then it is not a good target)
   - menu of backup reinforcers (premack)
   - response cost: tokens are deducted for inappropriate behavior (make sure students doesn’t zero out).
   - immediate feedback
   - monitor own work

Question 21

Common Classroom behaviors

Answer 21

1. escaping effortful tasks

2. attention

Question 22

Worsens ADHD symptoms

Answer 22

1. social environment (peers)
2. a boring (vs. novel) task
3. individual work (vs. one-on-one — aide is EF)

Question 23

Is ADHD a real disorder?

Answer 23

YES!
1. etiology
Meets Wakefield (1999) criteria
a. signficant deficits in inhibition and attention that are critical for self regulation
b numerous domains of inmpairment (risks of harm) over development
2. differ from normal population

Question 24

What is the effectiveness of ADHD treatments?

Answer 24

Meds - 75-85%
behavioral techniques - 35-80%

MTA study concluded meds were superior; however,followup studies (Fabiano) found that after 36 months the differences subside.

Question 25

MTA Study?

Answer 25

MTA study concluded meds were superior; however,followup studies (Fabiano) found that after 36 months the differences subside. MTA - 600 children 7-9 years old -14 months In other areas of functioning (e.g., anxiety symptoms, academic performance, parent-child relations, and social skills), combination treatment was consistently superior to routine community care, whereas medication alone or behavioral treatment alone were not.

Question 26

Lanberg et al., 2011

Answer 26

Study found behavior treatment more effective in improving homework completion.