Transcript ADHD

Is ADHD overdiagnosed?
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Where do you stand on the diagnosis of
ADHD – do you think it is overdiagnosed?
Why or why not?
2. What factors might lead to
overdiagnosis of ADHD? What about
underdiagnosis?
3. What problems might result from
underdiagnosis or overdiagnosis?
Initial questions/myths to
be addressed
• Is ADHD a relatively new disorder?
• Are ADHD symptoms fairly common;
are we merely labeling normal
behavior as a disorder?
• Is ADHD/inattentive type similar to
the traditional combined type?
• Has the rate of ADHD increased in
the last twenty years?
Core Symptoms
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Inattention OR
Impulsivity
Hyperactivity
(recent DSM change)
• Central role of impairment
• Must be present before age 7
• Impairment in 2 or more settings
Associated features of
ADHD
• Learning problems
• Peer problems
• aggression, noncompliance
Diagnostic Issues
• Diagnosis based on history of
disorder
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Rating scales
Interviews
Observations
Best with two sources
• No medical test or lab measure to
determine diagnosis
Prognosis
• Chronic disorder extending into
adulthood
• 3 common outcomes:
– Minimal problems
– Some moderate problems
– Severe problems
Ineffective Treatments
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“talk” therapy
Play therapy
Elimination diets
Allergy treatments
Chiropractics
Pet therapy
Dietary supplements
Perceptual or motor training/sensory integration
training
Effective Treatments
Evidence-Based
1. Psychostimulant medications
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Ritalin (methylphenidate), Dexedrine,
Cylert
Concerta, Adderall
Strattera is new nonstimulant med
2. Behavior therapy
Main Benefits of Meds
• 2/3 of children show benefits; another
10% benefit from other; rest show no
response or adverse response
• Less classroom disruption
• Better behavior as rated by teacher
• More compliant with adult requests
• Increase in on-task behavior
• Better peer interactions
Other important points
• Needs to be long-term
• Few dysfunctional attributions
• No increase in risk for later
substance abuse
• Not sufficient
Limitations of drug
treatment
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Rarely sufficient
Not effective for all
No impact on some family variables
Removes incentives for behavioral tx
No long-term effects
Adverse Effects
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Irritability, moodiness
Stomaches, headaches
Insomnia
Loss of appetite – less growth
Motor movements, tics
Rebound effect
Behavior Modification
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Only psychosocial tx
Should be implemented first
Train parents and teachers
Extensive
Difficult
Punishment/response cost needed
Parent Training
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Establish house rules
Praise appropriate behavior
Use appropriate commands
When…then contingencies
Time out
Points/token systems
Continually evaluate and modify
School Interventions
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Clear classroom rules
Similar to parent stuff
Near teacher
Focus on academic performance
Home report cards
Combined interventions
• Produce better short-term effects
• Often preferred by parents