Transcript Child & Adolescent Attention Deficit Hyper Activity

 Assessment of ADHD
› Four 15 minute office visits
 Treatment is NOT an emergency
› Take your time
› Ensure diagnosis is correct
www.freedigitalphotos.net Break by Salvatore Vuono
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Assessment Tool
SNAP-IV
Teacher and Parent 18-item Rating Scale
 A norm-referenced checklist
› Designed to determine presence of ADHD symptoms
› Can be completed by a parent/caregiver or educator
 DSM-IV criteria for ADHD
› Must be at least 6 responses of “Quite a Bit” or “Very Much” (scored
2 of 3) to either of the:
 9 inattentive items, OR
 9 hyperactive-impulsive items, OR
 Both on the 18-item rating scale
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Assessment Tool
SNAP-IV
Teacher and Parent 18-item Rating Scale
Young person must meet the following criteria:
 Some symptoms present before age 12 years
 Some impairment present in two or more settings
› Social, academic or occupational
 Clear evidence of clinically significant impairment
› In social or academic functioning
› Must not be primarily due to any other factors or conditions
 Mood Disorder, Anxiety Disorder,
Dissociative Disorders, Personality Disorder
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Assessment Tool
SNAP-IV
Teacher and Parent 18-item Rating Scale
 Rating scale alone not sufficient to diagnose
 For diagnosis and clinical intervention must have:
› Complete history
› Appropriate physical examination
 Ensure DSM-V criteria is met
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Assessment Tool
SNAP-IV
Teacher and Parent 18-item Rating Scale
 If a SNAP-IV score of 18 or higher:
› Discuss important issues/problems in child’s/youth’s
life/environment
› Child Use the Child Functional Assessment (CFA) to determine
impact on functioning
› Youth: Screen for Depression
 Use the Kutcher Adolescent Depression Screen (KADS)
 Complete or use the Teen Functional Activities Assessment
(TeFA) to determine the impact on functioning
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Monitoring and Intervention Tools: ADHD
Monitoring
 CGI
 TeFA / CFA
 TASR-A
 SNAP-IV
Interventions (these do not replace medications or psychotherapies)
 PST
 WRP
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Children
Visit 1
Consider risk factors
Apply screening tool
Complete CFA
Complete SNAP-IV
Visit 2
SNAP-IV 18 item
CFA
Use PST
and WRP
If risk factors are substantial or if three or more positives answers on
either the Parent or Child Version of the Screening Tool or CFA
suggests dysfunction due to ADHD like symptoms - Use the
Psychotherapeutic Support for Children (PSC) and Stress
Reduction Prescription (WRP) (proceed to step 2 in 1 - 2 weeks.)
Complete SNAP-IV. Provide SNAP-IV to parents and teachers. Provide
information about ADHD and its treatment. Obtain informed consent to
allow discussion with the school.
If fewer than 3 positive answers on The Parent or Adolescent version of
the Screening Tool - consider other possible explanations for
signs/symptoms such as: environmental stressors, Oppositional Defiant
Disorder, Conduct Disorder, Learning Disorder.
Use the Psychotherapeutic Support for Children (PSC) and Worry
Reduction Prescription (WRP) and monitor again in a month and
repeat STEP I and review other possible psychiatric conditions.
If SNAP-IV 18 > 18 (or a mean score of greater than 1) and CFA shows
decrease in function - continue with PST and WRP strategies - proceed
to step 3 within a week. Review SNAP-IV from parents and teachers
for scores as above. Discuss ADHD and its treatment and encourage
“google search”.
If SNAP-IV 18 <18 (or a mean score of greater than 1) and shows no
decrease in function – continue with PST and WRP strategies and
monitor again in a month– advise to call if feeling worse or problems
escalate.
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Children
Visit 3
SNAP-IV 18
CFA
Use PST
and WRP
If SNAP-IV 18 remains > 18 (or a mean score of greater than 1) and
CFA shows functioning problems – proceed to diagnosis (review
DSM-V criteria) and treatment after discussion of ADHD and
treatment options**
If SNAP-IV 18 <18 (or a mean score of greater than 1) and CFA
shows no decrease in function – continue with PST and WRP
strategies - monitor again with SNAP-IV 18 and CFA in one month –
advise to call if feeling worse or problems escalate. Consider
Confident Parents: Thriving Kids.
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Youth
Visit 1
Consider risk factors
Apply screening tool
TeFA
SNAP-IV
Visit 2
SNAP-IV 18 item
TeFA
Use PST
and WRP
If risk factors are substantial or if two or more positives answers on
either the Parent or Adolescent Version of the Screening Tool or TeFA
suggests dysfunction due to ADHD like symptoms - Use
Psychotherapeutic Support for Teens (PST) and Stress Reduction
Prescription (WRP) , see page 21 - proceed to step 2 in 1 - 2 weeks
Provide SNAP-IV to parents and teachers (school contact can be
through parents if feasible). Complete SNAP-IV 18. Provide
information about ADHD and its treatment. Obtain informed consent to
allow discussion with the school.
If fewer than 3 positive answers on The Parent or Adolescent version of
the Screening tool - consider other possible explanations for
signs/symptoms such as: environmental stressors, Oppositional Defiant
Disorder, Conduct Disorder, Learning Disorder. Use PST (see page 29)
and WRP (see page 21) and monitor again in a month and repeat STEP I
and review other possible psychiatric conditions.
If SNAP-IV 18 > 18 (or a mean score of greater than 1) and TeFA
shows decrease in function - continue with PST and WRP strategies proceed to step 3 within a week. Review SNAP-IV 18 from parents and
teachers for scores as above. Discuss ADHD and its treatment and
encourage “google search”.
If SNAP-IV 18 <18 (or a mean score of greater than 1) and shows no
decrease in function – continue with PST and WRP strategies and
monitor again in a month– advise to call if feeling worse or problems
escalate.
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Visit 3
SNAP-IV 18
TeFA
Use PST
and WRP
If SNAP-IV 18 remains > 18 (or a mean score of greater than 1) and
TeFA shows decrease in function – proceed to diagnosis (review DSMV criteria) and treatment.
If SNAP-IV 18 <18 (or a mean score of greater than 1) and TeFA
shows no decrease in function – continue with PST and WRP
strategies - monitor again with SNAP-IV 18 and TeFA in one month –
advise to call if suicide thoughts or acts of self-harm occur or if
problems escalate.
freedigitalphotos Sujin Jetkasettakorn
Youth
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Co-morbidity in ADHD
 Approx. 30 – 50% of people with ADHD have other
psychiatric disorders
› Oppositional Defiant Disorder (ODD)
› Conduct Disorder (CD)
› Learning Disorder
› Disruptive Mood Dysregulation Disorder
 Discuss academic and behavioral performance
› With teachers and guidance counselor
› Address possibility of a learning disability
› Specialized learning assessments through school
 Develop treatment plan for each disorder
› Address ADHD first as other disorder often
improves as ADHD improves
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Co-morbidity in ADHD
 Begin treatment
 Refer child/youth to specialty services or Stronger Families
› For more intensive behavioral or family interventions
› Many with ADHD co-morbid with ODD, CD, LD, DMDD, MDD
require specialty services
› Primary care provider should be part of the treatment plan
 If learning disability is suspected:
› Refer for educational psychological testing
› Contact school
› Remedial learning strategies
› Informed written consent to contact school
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www.freedigitalphotos.net by Salvatore Vuono
Confident Parents: Thriving Kids
 Evidence-based, family-focused coaching
intervention for parents
 Effective in preventing, reducing and
reversing mild to moderate behavioural
problems for children aged 3-12
 Coaching delivered via telephone at no cost
to patients
 Operational hours include evenings and
weekends
 Physician referral required (form in your binder)
 Offered by the Canadian Mental Health
Association – BC Division
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Table Discussion
 Which of these tools or techniques discussed do you currently
use?
 How do you see this fitting into your context?
 How can non-clinician team members contribute to
administration and completion of the tools?
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appendix – optional slides
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Canadian Attention Deficit
Hyperactivity Disorder Resource
Alliance (CADDRA)
www.pspbc.ca
CADDRA
 A national, independent, not-for-profit association.
 The voice of doctors who support patients with Attention
Deficit Hyperactivity Disorder (ADHD) and their families.
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CADDRA Vision
To improve the quality of life and reduce the suffering of
patients with ADHD and their families while maximizing their
potential across the lifespan.
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CADDRA Mandate
CADDRA is a national Canadian alliance of professionals
working in the area of ADHD who are dedicated to world
class research, education, training and advocacy in the area
of ADHD.
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CADDRA
 Information for physicians, parents, educators,
children, adolescents, and adults
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CADDRA Canadian ADHD Practice Guidelines
Third Edition (2011): Download
 Diagnosis and Overview of Visits
 Differential Diagnosis and Comorbid Disorders
 Specific Issues in the Management of Children with ADHD: Intervention
with Parents of Children Diagnosed with ADHD
 Specific Issues in the Management of Adolescent ADHD
 Specific Issues in the Management of ADHD in Adults
 Psychosocial Interventions and Treatments
 Pharmacological Treatment of ADHD
 CADDRA ADHD Assessment Toolkit (CAAT)
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CADRRA Tools www.caddra.ca
 Assessment and Follow-up Forms:  Handouts
› CADDRA ADHD Assessment Form
› Weiss Symptom Record (WSR)
› ADHD Checklist
› SNAP-IV-26
› CADDRA ADHD Information
and Resources
› CADDRA Child Assessment
Instructions
› CADDRA Adolescent
› Adult ADHD Self-Report Scale (ASRS)
Assessment Instructions
› Weiss Functional Impairment Rating Scale
Parent Report
(WFIRS-P)
› –CADDRA
Adult Assessment
› Weiss Functional Impairment Rating Scale –Instructions
Self Report (WFIRS-S)
› CADDRA Teachers Instructions
› CADDRA Teacher Assessment Form
› CADDRA Clinician ADHD Baseline/Follow-Up Form
› CADDRA Patient ADHD Medication Form
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WSR
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Teacher
Assessment
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WSIRS-P
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WFIRS-S
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ADHD Checklist
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ADHD
Assessment
Form
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Teacher
Instructions
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CADDRA
Medication
Tables
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Patient ADHD
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