ADHD Teleconference A free teleconference brought to you
ADHD Teleconference A free teleconference brought to you by ADDvisor. com and my. ADHD. com Part 1: Click ADHD at Your Fingertips to. Strategies edit Master title style by Harvey C. Parker, Ph. D. Part 2: Summer Management Tips by Bill Benninger, Ph. D. and Alan Graham, Ph. D. Copyright © 2004 All rights reserved. See: http: //www. myadhd. com/teleconferences. html 1
Disclaimer These slides and the accompanying presentation provide a general overview of strategies to manage attention-deficit/hyperactivity disorder Click to edit Master title style (ADHD) and related conditions and do not constitute medical, psychological, educational, or legal advice. Please consult your own health care provider or other professional for specific advice. 2
Finding Answers for ADHD • What is ADHD? • How does ADHD affect daily living? • What causes ADHD? • What procedures are used to assess ADHD? Click towork editbest? Master title style • What treatments • How can assessment tools, tracking tools, and treatment tools from my. ADHD. com help families, practitioners, educators, and adults? • Management Tips 3
What is ADHD? • …A medical condition characterized by inattention and/or hyperactivity-impulsivity. • …One of the most common mental disorders Click to edit Master title style among children, affecting approximately 5 to 7 % of school-age children and about 2 -5% of adults 4
Prevalence in the United States About 2 million children Click to edit Master title style About 5 million adults 5
Prevalence World Wide • • • Canada Australia New Zealand Germany India Click to China Netherlands Puerto Rico Japan Mexico Brazil edit 3. 8 -9. 4% kids 3. 4% of kids 6. 7% kids, 2 -3% teens 4. 2% children 5 -29% children Master title style 6 -9% children 1. 3% teens 9. 5% child & teens 7. 7% children approx. 5% children 5. 8% of 12 -14 year olds 6
Adult ADHD Remains Largely Undiagnosed* 15% Diagnosed Click to edit Master title style 85% Undiagnosed as an Adult *1999 analysis of a 1000 adult patient epidemiological database. Data on file, Lilly Research Laboratories. 7
ADHD is Not a Problem of: • Will power • Inadequate parenting • Lack of motivation to edit Master title style • Lack of Click intelligence • Laziness 8
ADHD is a neurological disorder that impairs • Regulation of attention • Regulation of motor activity • Regulation of impulsivity Click to edit Master title style 9
ADHD results in problems with • • Planning Organizing Starting and stopping activity Managing behavior Persisting on tasks Click to edit Master title style Problem solving Working memory These are called Executive Functions 10
DSM-IV Criteria: 6 of 9 Inattention Symptoms • • • Fails to give close attention to details Difficulty sustaining attention Does not seem to listen Does not follow through on instructions Difficulty Click organizing tasks Master or activities to edit title style Avoids tasks requiring sustained mental effort Loses things necessary for tasks Easily distracted Forgetful in daily activities 11
DSM-IV Criteria: 6 of 9 Hyperactive-Impulsive • • • Fidgets with hands or feet or squirms in seat Leaves seat in classroom inappropriately Runs about or climbs excessively Has difficulty playing quietly Is “on the. Click go” or to “driven a motor”title style editby. Master Talks excessively Blurts out answers before questions are completed Has difficulty awaiting turn Interrupts or intrudes on others 12
Other DSM-IV Criteria • • Developmentally Inappropriate Levels Duration of 6 Months Cross-setting Occurrence of Symptoms Impairment in Major Life Activities to edit Master title Onset of. Click Symptoms/Impairment by style 7 Exclusions: Severe MR, PDD, Psychosis Subtyping into Inattentive, Hyperactive, or Combined Types 13
AAP Assessment Guidelines • Diagnosis must meet DSM IV criteria • Evidence of symptoms and impairment must come from parents or caregivers • Evidence of symptoms and impairment must come from classroom teacher or other school professional • Assessment. Click shouldto include evaluationtitle for co-morbid edit Master style conditions • Rating scales designed specifically to assess ADHD symptoms should be used in addition to narrative reports, observations, etc. • Other diagnostic tests are not routinely used to establish presence of ADHD but may be used to discover other conditions 14
Potential Areas of Impairment Occupational/vocational Motor vehicle accidents Injuries Click to edit Master title style Smoking and SUD Legal difficulties Relationships Academic failure 15
ADHD has a Neurobiological Basis • Dysfunction of dopaminergic and noradrenergic systems • Dopamine and Click to are edit Master norepinephrine important in drugs that treat ADHD title style Arnsten AF. J Psychopharmacol 1997; 11: 151 -62; Madras BK, et al. Behav Brain Res 2002; 130: 57 -63; Russell VA. Behav Brain Res 2002; 130: 191 -6; Solanto MV. Behav Brain Res 2002; 130: 65 -71. 16
How do you get ADHD? Click to edit Master title style 17
ADHD Is highly heritable Depression IQ Click to edit Master title style Schizophrenia ADHD Height 0 0. 2 0. 4 0. 6 0. 8 Heritability estimate Heritability Estimate Faraone SV, et al. Child Adolesc Psychiatr Clin N Am 2001; 10: 299 -316, viii-ix; Faraone SV, et al. Am J Psychiatry 2001; 158: 1052 -7; MARK Web site. 18
Causes of ADHD • Heredity/Genetics • 25 -30% siblings • 15 -20% mothers 55 -92% identical twins 25 -30% fathers • Neurological Development Click to edit Master title style • Complications of pregnancy, fetal exposure to alcohol or tobacco, premature birth with minor brain hemorrhages (10 -15%) • Head trauma, brain hypoxia, infection, lead poisoning during early childhood (3 -5%) 19
Common Comorbid Diagnoses Click to edit Master title style Biederman et al. JAACAP 1996; 35: 343. Biederman et al. JAACAP 1999; 38: 966. Pliszka. J Clin Psychiatry 1998: 59(suppl 7): 50. Spencer et al. Pediatric Clin N Am 1999: 46: 915. 20
AAP Treatment Guidelines • Primary care physicians should establish treatment programs for ADHD • Clinicians, parents, teachers, and children should collaborate to target outcomes Click to edit Master title style • Medication and/or behavior therapy are appropriate treatments • Periodic, systematic follow-ups for the child should be done with monitoring for targeted symptoms. Information should be gathered from parents, teachers, and the child. 21
How can we help people with ADHD? Treatments for ADHD • Education • Medication • Behavior Modification Click to edit Master title style • Classroom/Workplace Accommodations 22
MTA Study—The Largest Study Comparing ADHD Treatments Which ADHD treatments (or combination) work best? 1. Medication (Med. Mgt) vs. Behavioral Tx (Beh) vs. Combination (Comb) over the long term Click to edit Master title style 2. State-of-art, intensive MTA treatments vs. standard care available in the community (CC), over the long term See: http: //www. myadhd. com/articles. html 23
Co-Occurring Disorders in MTA Children (n=579) 31% 40% 11% Master title style Click to edit 4% 14% 34% 24
MTA Study—Treatment Groups Four Treatment Groups (14 months) Medication alone (MPH dosed to last 12 hours) 2. Intensive behavioral treatment alone a. over 30 sessions for parent training Click to edit Master title style b. 8 week summer program c. behavior therapist for 12 wks in classroom d. daily reports from school to home 3. Combined medication & behavioral treatment 4. Community-based care (control) 1. Source: MTA Study Group, Arch Gen Psych, 1999, 56, 1073 -1086. 25
MTA Study Results All treatment arms found to be effective on an absolute basis Medication alone Medication + behavioral treatment Click to edit Master title style Nearly equally effective and superior to: • Behavioral treatment alone • Community based treatment Source: MTA Study Group, Arch Gen Psych, 1999, 56, 1073 -1086. 26
% “Normalized” at 14 -Month Endpoint MTA Groups vs Classroom Controls Click to edit Master title style 27
Commonly Used Stimulant Medications for ADHD • Methylphenidate (MPH) Products • Ritalin short & mid-acting forms • Concerta long-acting • Metadate CD mid-acting • Ritalin Click LA mid-acting to edit Master title style • Focalin mid-acting • Amphetamine Products • Adderall mid-acting • Adderall XR long-acting • Dexedrine mid-acting spansule • Dextrostat mid-acting Short acting = 3 -5 hours; Mid-acting = 6 -8 hours; Long acting = 12 hours+ 28
Commonly Used Non-Stimulant Medications for ADHD • Nonstimulant Products • Strattera long-acting • Other Nonstimulants Products • Wellbutrin long-acting Click to edit Master title style • Tenex mid-acting • Clonidine mid-acting Short acting = 3 -5 hours; Mid-acting = 6 -8 hours; Long acting = 12 hours+ 29
Efficacy of Medication for ADHD • Improvements in core symptoms Øreduced hyperactivity Øreduced impulsivity Øimproved attention Click to edit Master title style • Improvements in related symptoms Øreduced oppositional behavior ØImproved social relations Øimproved academic performance Short acting = 3 -5 hours; Mid-acting = 6 -8 hours; Long acting = 12 hours+ 30
Adverse Effects of Stimulants Ø insomnia Ø decreased appetite Ø weight loss Ø headache Ø irritability Ø Stomachache Click to edit of. Master titlesymptoms style as it is Ø rebound agitation or exaggeration pre-medication wearing off Precautions Use cautiously in patients with marked anxiety, motor tics or with family history of Tourette syndrome, or history of substance abuse. Don't use if glaucoma or on MAOI. Abuse potential particularly in tablet form. Always consult your physician before using ADHD medications. 31
Adverse Effects of Strattera In children Ø decreased appetite Ø GI upset (can be reduced if medication taken with food) Ø sedation (can be reduced by dosing in evening) Ø lightheadedness In adults Click to edit Master title style Ø insomnia Ø sexual side effects Ø increased blood pressure Precautions Use cautiously in patients with hypertension, tachycardia, or cardiovascular or cerebrovascular disease because it can increase blood pressure and heart rate. Has some drug interactions. While extensively tested, short duration of population use. Always consult your physician before using ADHD medications. 32
Using Medication Effectively • American Academy of Pediatrics recommends that for treatment of ADHD physicians start with a low dose of medication and tritrate upward to find the optimal dose. • Optimal dose is the best Master individualized response with Click to edit title style minimal side effects. • Have a system in place to monitor treatment outcomes to find the optimal dose and adverse effects. Short acting = 3 -5 hours; Mid-acting = 6 -8 hours; Long acting = 12 hours+ 33
Treatment for ADHD can be improved by: • Empowering parents and providers with accurate information about best practices – creating connections between stakeholders and encourage greater communication – using an “educate the community” model Click to edit Master title style • Developing communication tools – web-based assessment tools – “checklists” for parents, teachers and doctors to guide each one’s role in assessment and treatment • Forming a coalition of parents, professionals, and policy makers 34
My. ADHD. com Tools to Empower Providers, Parents, and Adults • Assessment Tools Ø rating scales, checklists, and child/adult history forms • Tracking Click. Tools to edit Master title style Ø rating scales • Treatment Tools Ø worksheets for skill improvement • Library Tools Ø learning resources (articles, books, newsletters, announcements, etc. ) 35
Assessment Tools • Vanderbilt Assessment Scale (Parent and Teacher Informant Versions) (Wolraich, et al. ) • SNAP-IV (18 items) (Swanson, et al. ) • SNAP-IV-C (80 Items) (Swanson, et al. ) • ADHD Symptom Checklist (child and adolescent version)Click in English and Spanish to edit Master title style • ADHD Symptom Checklist (adult self-report and adult observer-report versions) in English and Spanish • Childhood Disorders Checklist • Child and Adolescent History Form • Adult Psychosocial History Form • Novotni Social Skills Checklists (self and observer versions) See: http: //www. myadhd. com/assessmenttools. html 36
Tracking Tools • SNAP-IV (Swanson, et al. ) • ADHD Symptom Checklist (child and adolescent version) Click to edit Master title style • ADHD Symptom Checklist (adult self-report and adult observer report versions) • ADHD Monitoring System (Rabiner, 1999) See: http: //www. myadhd. com/trackingtools. html 37
How Assessment and Tracking Tools Can Be Completed and Sent? • View form on screen then print and complete and send by mail or fax. • Download form as PDF file then print and complete and send by mail or fax. Click to edit Master title style • Transmit form electronically using the Subscriber Administration Page. – Select from over a dozen forms (Eng/Span) that you would like to send for completion. – Send form easily to multiple teachers (e. g. , middle/high school) using my. ADHD. com address book feature. – Once received, forms can be archived in your private account. Received forms can be easily transmitted to others for review. 38
Using Your my. ADHD. com Subscriber Administration Page Click to edit Master title style See: http: //www. myadhd. com/sampleadminpage 1. html 39
Treatment Tools Worksheets to improve skills Click to edit Master title style for children, adolescents, and adults. See: http: //www. myadhd. com/treatmenttools. html 40
Types of Treatment Tools Children Behavior Management Adolescents Behavior Management Adults Organizational Strategies Click to. Study edit Master title style Strategies Career Planning Study Strategies Social Skills Medication Management Anger Management Stress Management 41
My. ADHD. com Medication Chart Click to edit Master title style See: http: //www. myadhd. com/treatment_tools/medicationchart. html 42
Daily Report Cart Click to edit Master title style See: http: //www. myadhd. com/treatment_tools/sample 3003 dailyreportcard. html 43
Writing Behavior Contracts Click to edit Master title style 44
Home Token Economy Systems Click to edit Master title style See: http: //www. myadhd. com/treatment_tools/sample 3004 hometokeneconomy. html 45
Anger Management Worksheet Click to edit Master title style 46
Changing Angry Thoughts Click to edit Master title style 47
Don’t Call Out! Raise Your Hand Click to edit Master title style See: http: //www. myadhd. com/treatment_tools/sample 3009 raiseyourhand. html 48
Homework Self-Check Click to edit Master title style 49
Overcoming Roadblocks to Family Communication Click to edit Master title style See: http: //www. myadhd. com/treatment_tools/sample 7001 familycommunication. html 50
Problem Solving Worksheet Click to edit Master title style 51
Types of Resumes Click to edit Master title style See: http: //www. myadhd. com/treatment_tools/sample 9007 typesofresumes. html 52
Writing an Effective Cover Letter Click to edit Master title style 53
Keeping a Personal Budget Click to edit Master title style See: http: //www. myadhd. com/treatment_tools/sample 1201 personalbudget. html 54
Tackling Housecleaning Click to edit Master title style 55
Conclusions • ADHD is a chronic condition that has significant affects on learning, behavior, socialization, and performance across the lifespan. • ADHD is prevalent in every country where it has been studied. • ADHD can persist into adulthood. Click to edit Master title style • ADHD treatments have been well studied. • Multimodal treatments work best and involve a combination of education about the condition, medication, counseling, behavior management, and school and workplace accommodations and interventions. • Enhanced communication among stakeholders (providers, parents, educators, adults with ADHD) can lead to maximum improvement. 56
Summer Management Tips Bill Benninger, Ph. D. and Alan Graham, Ph. D. • Medication • Structure • Accountability Click to edit Master title style • Social skills See: http: //www. ADDvisor. com 57
Summer Management Tips Summer Activities to Consider • Camp • Sports • Vacations Click to edit Master title style • Summer school • Jobs • Family projects • Tutoring 58
Contact Information • My. ADHD. com – Email: info@myadhd. com – Harvey C. Parker, Ph. D. Phone: (954) 792 -8100 • ADDVisor 1 -866 -ADDvisor Click to edit Master title – Bill Benninger • Email: Bill@ADDvisor. com • Phone: 1 -614 -251 -0400 – Alan Graham • Email: Alan@ADDvisor. com • Phone: 1 -847 -824 -1235 See: http: //www. myadhd. com style See: http: //www. ADDvisor. com 59
Other Resources Children and Adults with Attention Deficit /Hyperactivity Disorders (CHADD) www. chadd. org Attention Deficit Disorders Association (ADDA) Click to http: //www. add. org/ American Academy of Child and Adolescent Psychiatry (AACAP) http: //www. aacap. org/ American Academy of Pediatrics www. aap. org A. D. D. title Ware. House edit Master style www. addwarehouse. com Learning Disability Association of America http: //www. ldanatl. org/ See: http: //www. myadhd. com/organizations. html 60
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