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ADHD

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on 16 March 2016

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Transcript of ADHD

DSM-IV vs. DSM 5

Adulthood ADHD (17+)

Adults must have five present symptoms

Symptoms present prior to the age of 12,
DSM IV required item prior to the
age of 7.
DSM V does not exclude individuals with
Autism from receiving a dual
diagnosis of ADHD

Attention Deficit Hyperactivity Disorder
Diagnosis
The medical diagnosis is made by medical practitioners based on:

DSM-5 Criteria

Input from family and school personnel (e.g., BASC)

Tests to rule out that symptoms can’t be better explained

Assessment of typical behavior based on age & developmental level

Inattention Symptoms
6 or more of the following symptoms must be present for at least 6 months:

Often fails to give close attention to details or makes careless
mistakes
Often has difficulty sustaining attention in tasks or play activities
Often does not seem to listen when spoken to directly
Often does not follow through on instructions and fails to finish
schoolwork, chores or duties in the workplace
Often has difficulty organizing tasks and activities
Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort
Often loses things necessary for tasks or activities
Is often easily distracted by extraneous stimuli
Is often forgetful in daily activities

Hyperactive/Impulsive Symptoms

6 or more of the following symptoms must be
present for at least 6 months:

Often fidgets with or taps hands or feet or squirms in
seat
Often leaves seat in situations when remaining seated is
expected
Often runs about or climbs in situations where is it
inappropriate
Often unable to play or engage in leisure activities quietly
Is often “on the go” acting as if “driven by a motor”
Often talks excessively
Often blurts out an answer before a question has been
completed
Often has difficulty waiting his or her turn
Often interrupts or intrudes on others

Additional DSM Criteria

Several inattentive or hyperactive-impulsive
symptoms were present before age 12 years

Several symptoms are present across two or more
settings

There is clear evidence that the symptoms interfere
with, or reduce the quality of functioning
across settings

The symptoms are not better explained by another
mental disorder

Prevalence
DSM: 5% of children and 2.5% of adults

CDC: 11% nationwide; 5-7% in CA

Higher rates in boys than girls overall (2-1)

Higher presence in girls than boys in ADHD-I subtype
Comorbidity
ODD*
Conduct Disorder*
SLD*
Anxiety
Depression
Tourette’s
Autism
Bipolar Disorder
Substance use disorders

Treatment

(most popular)
Pill, Patch, Liquid

Adderall
Concerta
Dexedrine
Focalin
Metadate
Methylin and Methylin ER
Ritalin, Ritalin SR, Ritalin LA
Vyvanse

Medication Considerations
Family decision
Medical Decision
constant monitoring of a pediatrician
Offer resources and feedback

Side Effects
Decreased Appetite, Sleep Problems
Personality Change (Flat personality)
Less common
Tics
Strattera
Suicidal Thoughts

Medication




Therapy Education and
Training

Medications



Strattera
Intuniv
Kapvay (used only in combination of a stimulant ADHD medication)




Desipramine
Imipramine
Nortriptyline
Wellbutrin

What do you Know About ADHD?
One of the most common childhood
neurodevelopmental disorders

- Subtypes:
Predominantly Inattentive
Predominantly Hyperactive/Impulsive
Combined

What is ADHD?
Stimulants
Non-Stimulants
Antidepressants
Exact cause is not known

Most probable cause: Genes & PFC

Other possible risk factors:
Environmental factors
(lead, smoking & drinking during
pregnancy, low birth weight)
Traumatic brain injury

Sugar & food additives :-(
Etiology
Vignettes
Please form groups of 4
What to Take Away...
ADHD is one of the most common disorders we will see in schools
Therapy
Working With Families and Teachers
Structure
Classroom and the home
Stress Management Techniques
Positive/ Negative Feedback
Reduction of large tasks into smaller
manageable parts
Lesson plan modifications
Reducing Visual Stimuli
Ex dibbles


ADHD in Educational Planning
504 Plan

1973 American with
Disabilities Act
Subpart D
Preschool, elementary,
and secondary education
Not federally funded but
legally mandated by the
Office of Civil Rights
1991- USDE included
ADHD as a qualifier for
a 504 Plan
IEP
Federally Funded
OHI- Other Health
Impairments
Qualifies for special
education services

Matthew, an 8-year-old boy, was referred to you by his teacher, Mrs. Davis, for poor grades in math. The teacher reported that Matthew frequently "spaces out" during math activities and/or is disruptive to the rest of the class by talking loudly or repeatedly getting in and out of his chair, behaviors which she believes are representative of ADHD. Mrs. Davis also tells you that she spoke with Matthew's mother and it seems he behaves similarly at home when he is asked to complete math homework. He tells her the assignment is stupid and proceeds to lock himself in his room.

What else would you like to know about Matthew?

How would you proceed to help Mrs. Davis?

Vignette 1
Vignette 2
A teacher comes to you for help regarding a girl named Samantha. The teacher explains that Samantha is 12 years old and has very recently been medically diagnosed with ADHD-I by her physician. Prior to Samantha's diagnosis, her teacher was concerned about Samantha's declining grades. She got along well with her peers, but often seemed disengaged in class assignments, quickly lost focus during group fade reading, and was extremely forgetful when it came to turning in assignments. Samantha's teacher was hoping that the medical diagnosis, along with prescribed medication, would improve Samantha's status in class, but that has yet to happen. Samantha's teacher is still concerned, and wants Samantha to be evaluated for special education.

Is there anything else you would like to know about Samantha?

How would you proceed?

Nicholas is a kindergartner in a general education
classroom. He was assessed during preschool and was found
to have Autistic-like behaviors, but did not qualify to receive a
formal diagnosis of Autism. Nicholas struggles with the sequencing of tasks and with multiple step directions. Previous teachers stated that Nicholas was very sensory and sought out things to touch and feel during school. They attributed Nicholas’ rocking back and forth to his need to gain some sensory input. Mrs. Cole, Nicholas’ current teacher, says that he is not disruptive in class and stays in his seat most of the time. However Nicholas most often does not finish his independent work and is falling behind in math and reading. Nicholas is currently receiving services from the OT, Occupational Therapist, and the Speech Pathologist and has a 1:1aid. During assessment for his Tri, Nicholas was unable to complete most assessments due to inattention and his scores were significantly sporadic, showing high and low scores in tests with similar or even the same constructs.

What questions would you like to ask Nicholas’
parents or the school staff?

What consideration do you think need to
be made when assessing Nicholas?
Vignette 3
Vignette 4
In November, the third month of the school year, Mrs. Thompson seeks consultation from you, the school psychologist/ counselor. Juan is in Mrs. Thompson’s 5th grade class and has been disruptive since the start of the school year. Mrs. Thompson states the Juan frequently calls out of turn and is never in his seat. Juan is gaining the reputation of being the class clown of fifth grade. Despite his comedic reputation Juan often gets in verbal and sometimes physical fights with peers over seemingly minor things. After a brief discussion with Juan teacher, you learn that Juan’s mother passed away this summer and his father has recently returned to his full time job. Juan’s behaviors are increasing each week and Mrs. Thompson is unable to carry out most of her lessons plans. She fears that the other students education will suffer.

What are some questions that you would want to ask about Juan?

How can you support both Juan and
Mrs. Thompson?



Vignette 5
Juliette, a fourth grade girl, has been referred to your office for her
behavior by her parents and teacher. She has become increasingly
difficult to manage in class and extremely disruptive to other’s learning.
Juliette appears to be unaware of what is happening during instruction
and is often reprimanded for “fiddling” with the many objects in her
desk. On many different occasions Juliette’s teacher has told her to
remove the objects from her desk and pay attention. This often results
in Juliette shouting that the teacher is being unfair and “picking on
her”. Her interactions with peers are very strained. Juliette is reported
to have difficulties with controlling her impulses at home and at school.
Juliet's parents have reported that at home she often refuses to do minor
requests, resulting in her siblings doing the majority of the household chores.

What questions would you like answered
about Juliette?

How would you support Juliette, her family and
her teacher?




Role of the School Psych or Counselor


- Recommend medication
- Diagnose
- Prescribe or dispense
medication


- Communicate with parents
- Supply medical professionals
with observation notes and questionnaires to assist with diagnosis
- Adhere to 504 plan and consult
with teachers
- If comorbidity is suspected,
carry out IEP procedures

What We Can Do:
What we Can Not Do:


Sarah Maloney & Candace Gamboa
Thank you
Cognitive Behavioral Therapy
Skills Training
(Parents, students, Teachers)
Play Therapy
Family Therapy
References
American Psychiatric Association. (2013). Diagnostic and
statistical manual of mental disorders (5th ed.). Arlington, VA:
American Psychiatric Publishing

Brown, R., L. A. Carpenter, & E. Simerly. (2005). Mental Health
Medications for Children. Guildford Press: New York

Merrell, Kenneth W., Ervin, Ruth, A., Peacock, Gretchen Gimpel. (2012). s
chool
psychology for the 21st century: foundations and practice
(2 nd ed.) New York, NY: Guilford Press

Jarratt, K., Riccio, C. A., & Siekierski, B. M. (2005). Assessment of attention
deficit hyperactivity disorder (ADHD) using the BASC and BRIEF.
Applied Neuropsychology, 12
(2), 83-93. doi:10.1207/s15324826an1202_4

Sharma, A. & Couture, J. (2014). A review of the pathophysiology, etiology,
and treatment of attention-deficit hyperactivity disorder (ADHD).
The Annals of Pharmacotherapy 48
(2), 209-225. doi: 10.1177/1060028013510699

U.S Department of Health and Human Services. National Institute of Mental
Health. (2012). Attention deficit hyperactivity disorder [pdf file].

Willcutt, Erik, (2012). The prevalence of DSM-IV attention-deficit/
hyperactivity disorder: a meta-analytic review.
Nerurotherapeutics: The Journal of the American Society for Experimental Neurotherapeutics, 9
(3), 490-499. doi 10.1007/s13311-012-0135-8
Full transcript