Attention Deficit

Hyperactivity Disorder
Presentation by Sean Sandag and
Whitney Badramraju

DSM-5 Diagnostic Criteria
A persistent pattern of inattention and/or hyperactivity-
impulsivity that interferes with functioning or
development (p. 59).

Culture-Related Diagnostic Issues
Region- prevalence based on diagnostic and
methodological practices
Culture- difference in attitudes towards childrens
behavior
U.S. identification rates:
African Americans/Latinos Caucasians

...informant symptom ratings may be influenced by culture



Gender-Related Diagnostic Issues
More frequent in males than females
o 2:1 in children
o 1:6:1 in adults
Females more likely to present primarily with
inattentive features
Functional Consequences of ADHD
Reduced school performance and academic attainment
Social rejection
Poorer occupational performance
o attendance attainment
Higher probability of unemployment



substance abuse incarceration
More likely to develop other disorders...
as adolescents as adults
conduct disorder antisocial personality disorder


More Functional Consequences...
More likely to be injured
o associated with symptoms of
hyperactivity/impulsivity
More frequent traffic accidents and violations
Inadequate or variable sustained effort
o perceived by others as laziness, irresponsibility,
non-compliant
Family relationships- discord and negative interactions
Peer relationships- rejection, neglect, or teasing
o associated with symptoms of inattention
Differential Diagnosis
Oppositional defiant disorder
o e.g. defiance vs. impulsivity
Intermittent explosive disorder
o share impulsive behavior
o aggression in IED
Other neurodevelopmental disorders
o stereotypic movement disorder (e.g. body rocking)
Specific learning disorder
o not impairing outside of academic work
Intellectual disability
o IEP vs. 504

Differential Diagnosis (continued)
Autism spectrum disorder
o inability to tolerate change vs. inability to control impulses
Reactive attachment disorder
Anxiety disorders
o rumination
Depressive disorders
o poor concentration in mood disorders
Bipolar disorder
o impulsivity and inattention episodic 4+ days
Disruptive mood dysregulation disorder
Substance use disorders

Personality Disorders and ADHD



fear of abandonment disorganization persistent pattern of
self-injury social intrusiveness inattentiveness
extreme ambivalence emotional dysregulation
cognitive dysregulation several symptoms must be
narcissistic present before age 12
aggressive
domineering
Differential Diagnosis (continued)
Psychotic disorders
Medication-induced symptoms of ADHD
Neurocognitive disorders
o late onset

Comorbidity
ODD co-occurs in approximately half of
children with combined presentation, and
about a quarter of children with
predominantly inattentive presentation
Conduct disorder co-occurs in about a
quarter of of children or adolescents with the
combined presentation
Comorbidity (continued)
Other co-morbid disorders:
Disruptive mood dysregulation
Specific learning disorder
Anxiety disorders
Major depressive disorder
Intermittent explosive disorder
Personality disorders (with adults)
Substance abuse disorders
Obsessive-compulsive disorder
Autism spectrum disorder

Treatment Planning
Preferred therapist characteristics
o calm and patient demeanor
o be clear about own emotional issues
o trusting, accepting relationship
o structured setting
o collaborative style of working with others involved
o comfortable with behavior management strategies
o clear developmental measurements
o flexibility in tailoring individual needs

Treatment Planning (continued)
Parent Management Training
o reduces parent stress and increases parental sense of control/self-esteem
o most interventions are 8 to 12 sessions (ages 4 to 12)
o educates parents on ADHD
o promotes encouragement of socially competent behavior
o models good communication skills
o consistent rewards and consequences
o adolescents do not respond as well
School-Based Interventions
o desirable behavior must be reinforced in multiple settings
o train teachers in selective attending and ignoring inappropriate behaviors
o matching academic materials to attention span and ability
o greatest improvements seen with contingency management and peer
tutoring
ADHD in the Classroom
Behavioral interventions- antecedent based strategies
o Teachers can post and review classroom rules
rules should be few and phrased positively
frequent praise when rules are followed
o Give students choices for assignments and homework
Behavioral interventions- contingent based strategies
o contingent positive reinforcement
token rewards
praise immediately after desired behavior
rewards should be individualized and rotated
timeout- can be punishment or reward
Self-regulation intervention
o teaches students to monitor their own behavior
ADHD in the Classroom (continued)
Academic interventions
o behavioral interventions and medication have little effect on grades
o direct instruction
o peer tutoring
Home-school communication program
o daily report cards
Social relationship intervention
o does not produce lasting benefits alone
Collaborative consultation
o equal partnership between two partners (e.g., school counselor and
classroom teacher) to dene a problem and develop interventions
o Project PASS (Promoting Academic Success in Students)
o 1.) identify problem 2.) discuss possible interventions 3.) choose plan
teacher believes is feasible 4.) evaluate success of plan
Prognosis
No cure, but many ways to reduce symptoms
Multimodal treatment planning
o psychostimulant medication
o parent training help children reduce their
o teacher training impulsivity
Early interventions should focus on:
o resilience
o awareness of social cues
o decreasing oppositional behavior
Mitigates development of disruptive behavior disorder
References
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders-DSM-5
TM
(5
th
edition).
American
Psychiatric Publishing, Arlington, VA.
Seligman, L., & Reichenburg, L.W. (2012). Selecting Effective Treatments- A Comprehensive, Systematic Guide to Treating
Mental Health Disorders (4
th
edition). Hoboken, NJ: John Wiley & Sons, Inc.
DuPaul, G., Weyandt, L., Janusis, g., (2011). ADHD in the classroom:effective intervention strategies. Theory into Practice 50(1),
35-42.