This document discusses optimizing ADHD treatment when comorbid conditions are present. It summarizes research showing that comorbid oppositional defiant disorder (ODD), conduct disorder (CD), anxiety disorders, and major depression are common in individuals with ADHD. The document outlines treatment approaches for each comorbidity, noting that stimulant medications and behavioral parent training can help reduce ODD and CD symptoms. For anxiety disorders, behavioral therapies may be most effective, while depression requires careful evaluation and family counseling may help. Overall, the document advocates considering comorbidities to derive clinically useful subtypes for improving ADHD treatment outcomes.
This document discusses the importance of emotion in ADHD. It provides information on three websites that contain lectures and presentations on ADHD by Dr. Barkley, including over 10 hours of parent presentations and 25+ hours of professional presentations. It then outlines an objectives for Dr. Barkley's lecture on the important role of emotional impulsiveness and deficient emotional self-regulation in ADHD. Key findings from research are summarized that show the impact of poor emotion regulation in ADHD on functioning.
This topic is meant for the study purpose, for the final year undergraduate Physiotherapy students, who are studying under The Tamilnadu Dr.MGR Medical University (Govt University).
Anxiety Disorders in Kids...An Overview for Parents and TeachersStephen Grcevich, MD
Anxiety disorders are common in children and teens, affecting around 8% of adolescents. Left untreated, anxiety can interfere with daily functioning and academic or social performance. Cognitive behavioral therapy and selective serotonin reuptake inhibitors are both effective treatments, with the best results seen from a combination of the two. Common anxiety disorders in youth include separation anxiety disorder, specific phobias, generalized anxiety disorder, and social anxiety disorder.
Evaluation and Treatment of Bipolar and Related Disorders in Children and Ado...Stephen Grcevich, MD
In these lectures presented by Dr. Stephen Grcevich to child and adolescent psychiatry trainees at Akron Children's Hospital in January 2021, the following objectives were addressed:
Identify critical questions challenging our assumptions regarding treatment of bipolar disorder in kids.
Explore diagnostic challenges associated with comorbidity with other common mental health conditions.
Review key literature evaluating effective pharmacotherapy of pediatric bipolar disorder.
Examine available data on non-pharmacologic treatments in kids with bipolar disorder.
This document provides information about ADHD medications for teachers, including:
- Stimulant and non-stimulant medications are the main treatment options for ADHD.
- Medications can help improve attention span, reduce hyperactivity, and improve impulse control.
- Potential adverse effects include reduced appetite, insomnia, stomach aches, and irritability."
This study aims to track the development of children diagnosed with ADHD, bipolar disorder, or disruptive mood dysregulation disorder (DMDD) from ages 4 to 17 to better understand how these disorders manifest and change over time. Children in each diagnostic group will be interviewed using standardized assessments every two years. The researcher hypothesizes that as the study progresses, more children originally diagnosed with ADHD or bipolar disorder will meet criteria for DMDD instead. Identifying any misdiagnoses could help provide more appropriate treatment tailored to each child's needs.
Disruptive mood dysregulation disorder (DMDD) is characterized by frequent and severe temper outbursts that are disproportionate to the situation in children. To be diagnosed, a child must experience these outbursts at least 3 times a week along with persistent irritability. Between outbursts, the child's mood is irritable most of the day. DMDD often co-occurs with other disorders like depression, ADHD, and anxiety. Treatment involves therapies like CBT and medication management.
The document provides information on disruptive mood dysregulation disorder (DMDD), including diagnostic criteria, considerations, differentiating it from bipolar disorder, functional consequences, symptoms in school settings, assessment, treatment, prognosis, epidemiology, etiology, and school-based interventions. Key points include that DMDD involves severe and frequent temper outbursts disproportionate to situations, irritability, onset before age 10, and causes significant impairment. Left untreated, it often persists through adolescence and increases risks for other disorders.
This document discusses the importance of emotion in ADHD. It provides information on three websites that contain lectures and presentations on ADHD by Dr. Barkley, including over 10 hours of parent presentations and 25+ hours of professional presentations. It then outlines an objectives for Dr. Barkley's lecture on the important role of emotional impulsiveness and deficient emotional self-regulation in ADHD. Key findings from research are summarized that show the impact of poor emotion regulation in ADHD on functioning.
This topic is meant for the study purpose, for the final year undergraduate Physiotherapy students, who are studying under The Tamilnadu Dr.MGR Medical University (Govt University).
Anxiety Disorders in Kids...An Overview for Parents and TeachersStephen Grcevich, MD
Anxiety disorders are common in children and teens, affecting around 8% of adolescents. Left untreated, anxiety can interfere with daily functioning and academic or social performance. Cognitive behavioral therapy and selective serotonin reuptake inhibitors are both effective treatments, with the best results seen from a combination of the two. Common anxiety disorders in youth include separation anxiety disorder, specific phobias, generalized anxiety disorder, and social anxiety disorder.
Evaluation and Treatment of Bipolar and Related Disorders in Children and Ado...Stephen Grcevich, MD
In these lectures presented by Dr. Stephen Grcevich to child and adolescent psychiatry trainees at Akron Children's Hospital in January 2021, the following objectives were addressed:
Identify critical questions challenging our assumptions regarding treatment of bipolar disorder in kids.
Explore diagnostic challenges associated with comorbidity with other common mental health conditions.
Review key literature evaluating effective pharmacotherapy of pediatric bipolar disorder.
Examine available data on non-pharmacologic treatments in kids with bipolar disorder.
This document provides information about ADHD medications for teachers, including:
- Stimulant and non-stimulant medications are the main treatment options for ADHD.
- Medications can help improve attention span, reduce hyperactivity, and improve impulse control.
- Potential adverse effects include reduced appetite, insomnia, stomach aches, and irritability."
This study aims to track the development of children diagnosed with ADHD, bipolar disorder, or disruptive mood dysregulation disorder (DMDD) from ages 4 to 17 to better understand how these disorders manifest and change over time. Children in each diagnostic group will be interviewed using standardized assessments every two years. The researcher hypothesizes that as the study progresses, more children originally diagnosed with ADHD or bipolar disorder will meet criteria for DMDD instead. Identifying any misdiagnoses could help provide more appropriate treatment tailored to each child's needs.
Disruptive mood dysregulation disorder (DMDD) is characterized by frequent and severe temper outbursts that are disproportionate to the situation in children. To be diagnosed, a child must experience these outbursts at least 3 times a week along with persistent irritability. Between outbursts, the child's mood is irritable most of the day. DMDD often co-occurs with other disorders like depression, ADHD, and anxiety. Treatment involves therapies like CBT and medication management.
The document provides information on disruptive mood dysregulation disorder (DMDD), including diagnostic criteria, considerations, differentiating it from bipolar disorder, functional consequences, symptoms in school settings, assessment, treatment, prognosis, epidemiology, etiology, and school-based interventions. Key points include that DMDD involves severe and frequent temper outbursts disproportionate to situations, irritability, onset before age 10, and causes significant impairment. Left untreated, it often persists through adolescence and increases risks for other disorders.
Dmdd disruptive mood dysregulation disorderHarsh shaH
DMDD is a new diagnosis in the DSM-5 for children who experience frequent and severe temper outbursts that impair their daily functioning. It was created to more accurately diagnose children previously diagnosed with bipolar disorder. Children with DMDD experience chronic irritability and temper outbursts at least 3 times per week that are out of proportion to triggers. Treatment involves medication such as antidepressants and antipsychotics as well as psychotherapy. DMDD aims to reduce misdiagnosis of bipolar disorder in children and correctly identify those with severe irritability issues.
The document discusses anxiety in children and adolescents. It describes the differences between depressed mood versus a depressive episode, and lists the diagnostic criteria for a major depressive episode. It also discusses irritable mood and the various conditions it could indicate. The document provides information on generalized anxiety disorder, including prevalence, genetics, neurotransmitters involved, and treatment options. It covers specific phobias and social phobia, including diagnostic criteria, prevalence, etiology, and treatment.
This document discusses the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in children and adults, focusing on clinical aspects of medication management. It describes how stimulant medications like methylphenidate and amphetamines are the best documented and most effective treatment for ADHD symptoms. Behavioral therapies can also be effective, either alone or in combination with medication. The optimal treatment is medication management combined with behavioral therapy.
Assessment and management of anxiety in children and youth for family physici...tkettner
The document discusses childhood and adolescent anxiety, outlining various types of anxiety disorders like separation anxiety, social phobia, and generalized anxiety disorder. It provides information on recognizing symptoms of anxiety in children and teens, as well as evidence-based treatment approaches like cognitive behavioral therapy and medication. Screening tools are also presented to help identify anxiety disorders and assess functioning, risk of depression, and suicide risk.
Zoned, Stoned And Blown Pain Psych R X And C D Cady At OliverLouis Cady, MD
Review by Louis B. Cady, MD (Cady Wellness Institute) of the interdigitation between psychiatric disorders, chemical dependency and issues in treatment and recovery. This presentation reviews the enormous intertwinement between untreated ADHD and the development and maintenance of substance use and chemical dependency, examining both biological and psychodynamic influences. It concludes with tips from the recovery community and recommendations on how treatment teams can collaborate with each other.
Treating Anxiety Disorders in Children and Adolescents - Presenter: Laura Ma...Akron Children's Hospital
This document provides information from a presentation by Dr. Laura A. Markley on treating anxiety disorders in children and adolescents. It discusses the signs and symptoms of anxiety disorders in youth and acknowledges that psychotherapy is first-line treatment. It examines the evidence for medications to treat anxiety disorders in children, including SSRIs which have the most evidence but many are off-label. Key points include starting low doses of SSRIs and combining medication with CBT for best outcomes in disorders like OCD.
Horn, Deborah e[1]. neurological differences between adhd and childhood bipol...William Kritsonis
Dr. Kritsonis is Tenured Professor of Educational Leadership at Prairie View A&M University – Member of the Texas A&M University System. He teaches in the PhD Program in Educational Leadership. Dr. Kritsonis taught the Inaugural class session in the doctoral program at the start of the fall 2004 academic year. In October 2006, Dr. Kritsonis chaired and graduated the first doctoral student to earn a PhD in Educational Leadership at Prairie View A&M University. Since then, Dr. Kritsonis has chaired 22 doctoral dissertations along with serving as a committee member on many others.
Disruptive, Impulse Control & Conduct Disorders for NCMHCE StudyJohn R. Williams
Quick review of the essential points— DSM5 diagnosis criteria, assessments, treatments—of these disorders to better prepare for the National Clinical Mental Health Counseling Exam. This can be used like flashcards or as a presentation.
The document discusses medications for mental illness in adolescents. It covers topics like side effects, time to onset of effects, monitoring medication effectiveness and safety, and tools/resources for patients and providers. The presentation addresses prevailing attitudes toward psychotropic medications in youth and promotes education on proper medication use and monitoring to promote mental wellness. Resources for further information on mental health medications are also provided.
This document discusses differentiating between attention-deficit/hyperactivity disorder (ADHD) and bipolar disorder in children. It poses four key questions about whether they are separate illnesses, overlapping syndromes, coexistent symptoms, or if ADHD is a warning sign of bipolar disorder. It then provides background on the history and diagnostic criteria of ADHD, as well as statistics on its prevalence. It also discusses the challenges of diagnosing pediatric bipolar disorder and lists common developmental manifestations of manic symptoms in children. The document notes that ADHD and bipolar disorder are highly comorbid conditions and explores some ways to differentiate between the two.
Attention deficit Hyperactivity Disorder (ADHD) (justpsychiatry)Waleed Ahmad
A presentation for undergraduate Education on ADHD. for more, and for original PPTXs, visit:
https://psych.thinkific.com
My question bank:
https://psych.thinkific.com/courses/Psychiatry-question-bank-for-MRCPsych
Mood disorders in preschool and primary school childrenCatina Feresin
This document discusses mood disorders in preschool and primary school children. It proposes two new research studies: 1) including a teacher in Parent-Child Interaction Therapy when the caregiver shows affective disorders, to help the caregiver participate effectively in treatment; and 2) a three-step early prevention program in primary schools involving screening, diagnosis, and teacher-clinician collaboration on treatment to identify and treat mood disorders early. It also proposes using fMRI to study brain activity in depressed preschoolers undergoing therapy with and without teacher involvement. The goal is to validate approaches to better identify and treat mood disorders in young children to prevent psychiatric problems later in life.
The document discusses attention deficit hyperactivity disorder (ADHD), including:
1. It provides statistics on the prevalence of ADHD in school-aged children and discusses different diagnoses under the DSM-IV criteria.
2. It discusses the neurological basis of ADHD and how stimulant medications like Ritalin work to improve symptoms by affecting neurotransmitters in the brain.
3. It outlines challenges children with ADHD face and emphasizes the importance of a multimodal treatment approach including medication, behavioral management, and academic support.
Adjustment disorder is an abnormal reaction to an identifiable stressor that results in emotional or behavioral symptoms and impairment. It is commonly seen in children who experience depressed mood, irritability, impaired concentration and sleep issues after stressful events. Treatment involves psychotherapy and sometimes medication to alleviate symptoms. Prevention focuses on building coping skills, conflict resolution training and supportive relationships.
This document provides information about mood disorders and suicide risk. It discusses the signs and symptoms of mood disorders like major depression and bipolar disorder. It notes that mood disorders are common in children and adolescents and often involve comorbid conditions. Left untreated, mood disorders can negatively impact school performance and social functioning and increase risks of self-harm and suicide. The document outlines strategies for recognizing mood disorders in students and assisting students who are recovering. It also provides guidance on assessing suicide risk and intervening to help ensure student safety and access to appropriate treatment and support.
In this presentation, Dr. Steve Grcevich will...
Explore the rationale for regular consideration of deprescribing in children, teens and adults with mental health conditions.
Examine the indications for deprescribing in individual patients.
Consider a process for simplifying complex medication regimens in patients with suboptimal therapeutic benefits and/or unacceptable adverse effects.
ADHD is a developmental disorder affecting 3-6% of children that impacts executive function in the brain. It causes problems with attention span, impulse control, and activity level. The main symptoms are inattention, hyperactivity, and impulsivity. While a real disorder, ADHD is often underestimated and management includes medication, therapy, classroom support, and nutrition.
Diagnosis And Treatment Of Attention Defect Hyperactivity Disorder (ADHD)Arwa H. Al-Onayzan
ADHD is diagnosed through clinical history, examination, and sometimes investigations. It is characterized by inattention, hyperactivity, and impulsivity. Treatment includes non-pharmacological options like behavior management as well as pharmacological options like stimulant medications which are the first-line treatment.
Introduction to Depressive Disorders in Children and AdolescentsStephen Grcevich, MD
This is the slide set to the lectures I provided to the medical staff of Child and Adolescent Behavioral Health in Canton, OH during the Fall-Winter of 2018
The document discusses oppositional defiant disorder (ODD), including its diagnosis, clinical features, course, prognosis, treatment, and relationship to other disruptive behavior disorders like conduct disorder. Some key points include:
- ODD is defined by a pattern of negativistic, hostile, and defiant behaviors toward authority figures. It affects around 8-16% of children.
- It commonly co-occurs with disorders like ADHD, depression, and anxiety. Twin studies suggest it has a genetic component.
- Children with ODD may have elevated levels of adrenal androgens like DHEA and DHEAS compared to controls.
- If left untreated, a minority of cases (around 5%) may
This document discusses Attention Deficit Hyperactivity Disorder (ADHD) and how the diagnostic criteria for ADHD has been updated in the DSM-5 to better characterize ADHD in adults. It notes that ADHD often continues from childhood into adulthood. The document then discusses common clinical histories seen in adults with ADHD, domains of impairment associated with ADHD, and the link between ADHD and addiction, noting people with ADHD are vulnerable to substance abuse to try and self-medicate their symptoms. It emphasizes the importance of treating both ADHD and any co-occurring addictions.
Dmdd disruptive mood dysregulation disorderHarsh shaH
DMDD is a new diagnosis in the DSM-5 for children who experience frequent and severe temper outbursts that impair their daily functioning. It was created to more accurately diagnose children previously diagnosed with bipolar disorder. Children with DMDD experience chronic irritability and temper outbursts at least 3 times per week that are out of proportion to triggers. Treatment involves medication such as antidepressants and antipsychotics as well as psychotherapy. DMDD aims to reduce misdiagnosis of bipolar disorder in children and correctly identify those with severe irritability issues.
The document discusses anxiety in children and adolescents. It describes the differences between depressed mood versus a depressive episode, and lists the diagnostic criteria for a major depressive episode. It also discusses irritable mood and the various conditions it could indicate. The document provides information on generalized anxiety disorder, including prevalence, genetics, neurotransmitters involved, and treatment options. It covers specific phobias and social phobia, including diagnostic criteria, prevalence, etiology, and treatment.
This document discusses the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in children and adults, focusing on clinical aspects of medication management. It describes how stimulant medications like methylphenidate and amphetamines are the best documented and most effective treatment for ADHD symptoms. Behavioral therapies can also be effective, either alone or in combination with medication. The optimal treatment is medication management combined with behavioral therapy.
Assessment and management of anxiety in children and youth for family physici...tkettner
The document discusses childhood and adolescent anxiety, outlining various types of anxiety disorders like separation anxiety, social phobia, and generalized anxiety disorder. It provides information on recognizing symptoms of anxiety in children and teens, as well as evidence-based treatment approaches like cognitive behavioral therapy and medication. Screening tools are also presented to help identify anxiety disorders and assess functioning, risk of depression, and suicide risk.
Zoned, Stoned And Blown Pain Psych R X And C D Cady At OliverLouis Cady, MD
Review by Louis B. Cady, MD (Cady Wellness Institute) of the interdigitation between psychiatric disorders, chemical dependency and issues in treatment and recovery. This presentation reviews the enormous intertwinement between untreated ADHD and the development and maintenance of substance use and chemical dependency, examining both biological and psychodynamic influences. It concludes with tips from the recovery community and recommendations on how treatment teams can collaborate with each other.
Treating Anxiety Disorders in Children and Adolescents - Presenter: Laura Ma...Akron Children's Hospital
This document provides information from a presentation by Dr. Laura A. Markley on treating anxiety disorders in children and adolescents. It discusses the signs and symptoms of anxiety disorders in youth and acknowledges that psychotherapy is first-line treatment. It examines the evidence for medications to treat anxiety disorders in children, including SSRIs which have the most evidence but many are off-label. Key points include starting low doses of SSRIs and combining medication with CBT for best outcomes in disorders like OCD.
Horn, Deborah e[1]. neurological differences between adhd and childhood bipol...William Kritsonis
Dr. Kritsonis is Tenured Professor of Educational Leadership at Prairie View A&M University – Member of the Texas A&M University System. He teaches in the PhD Program in Educational Leadership. Dr. Kritsonis taught the Inaugural class session in the doctoral program at the start of the fall 2004 academic year. In October 2006, Dr. Kritsonis chaired and graduated the first doctoral student to earn a PhD in Educational Leadership at Prairie View A&M University. Since then, Dr. Kritsonis has chaired 22 doctoral dissertations along with serving as a committee member on many others.
Disruptive, Impulse Control & Conduct Disorders for NCMHCE StudyJohn R. Williams
Quick review of the essential points— DSM5 diagnosis criteria, assessments, treatments—of these disorders to better prepare for the National Clinical Mental Health Counseling Exam. This can be used like flashcards or as a presentation.
The document discusses medications for mental illness in adolescents. It covers topics like side effects, time to onset of effects, monitoring medication effectiveness and safety, and tools/resources for patients and providers. The presentation addresses prevailing attitudes toward psychotropic medications in youth and promotes education on proper medication use and monitoring to promote mental wellness. Resources for further information on mental health medications are also provided.
This document discusses differentiating between attention-deficit/hyperactivity disorder (ADHD) and bipolar disorder in children. It poses four key questions about whether they are separate illnesses, overlapping syndromes, coexistent symptoms, or if ADHD is a warning sign of bipolar disorder. It then provides background on the history and diagnostic criteria of ADHD, as well as statistics on its prevalence. It also discusses the challenges of diagnosing pediatric bipolar disorder and lists common developmental manifestations of manic symptoms in children. The document notes that ADHD and bipolar disorder are highly comorbid conditions and explores some ways to differentiate between the two.
Attention deficit Hyperactivity Disorder (ADHD) (justpsychiatry)Waleed Ahmad
A presentation for undergraduate Education on ADHD. for more, and for original PPTXs, visit:
https://psych.thinkific.com
My question bank:
https://psych.thinkific.com/courses/Psychiatry-question-bank-for-MRCPsych
Mood disorders in preschool and primary school childrenCatina Feresin
This document discusses mood disorders in preschool and primary school children. It proposes two new research studies: 1) including a teacher in Parent-Child Interaction Therapy when the caregiver shows affective disorders, to help the caregiver participate effectively in treatment; and 2) a three-step early prevention program in primary schools involving screening, diagnosis, and teacher-clinician collaboration on treatment to identify and treat mood disorders early. It also proposes using fMRI to study brain activity in depressed preschoolers undergoing therapy with and without teacher involvement. The goal is to validate approaches to better identify and treat mood disorders in young children to prevent psychiatric problems later in life.
The document discusses attention deficit hyperactivity disorder (ADHD), including:
1. It provides statistics on the prevalence of ADHD in school-aged children and discusses different diagnoses under the DSM-IV criteria.
2. It discusses the neurological basis of ADHD and how stimulant medications like Ritalin work to improve symptoms by affecting neurotransmitters in the brain.
3. It outlines challenges children with ADHD face and emphasizes the importance of a multimodal treatment approach including medication, behavioral management, and academic support.
Adjustment disorder is an abnormal reaction to an identifiable stressor that results in emotional or behavioral symptoms and impairment. It is commonly seen in children who experience depressed mood, irritability, impaired concentration and sleep issues after stressful events. Treatment involves psychotherapy and sometimes medication to alleviate symptoms. Prevention focuses on building coping skills, conflict resolution training and supportive relationships.
This document provides information about mood disorders and suicide risk. It discusses the signs and symptoms of mood disorders like major depression and bipolar disorder. It notes that mood disorders are common in children and adolescents and often involve comorbid conditions. Left untreated, mood disorders can negatively impact school performance and social functioning and increase risks of self-harm and suicide. The document outlines strategies for recognizing mood disorders in students and assisting students who are recovering. It also provides guidance on assessing suicide risk and intervening to help ensure student safety and access to appropriate treatment and support.
In this presentation, Dr. Steve Grcevich will...
Explore the rationale for regular consideration of deprescribing in children, teens and adults with mental health conditions.
Examine the indications for deprescribing in individual patients.
Consider a process for simplifying complex medication regimens in patients with suboptimal therapeutic benefits and/or unacceptable adverse effects.
ADHD is a developmental disorder affecting 3-6% of children that impacts executive function in the brain. It causes problems with attention span, impulse control, and activity level. The main symptoms are inattention, hyperactivity, and impulsivity. While a real disorder, ADHD is often underestimated and management includes medication, therapy, classroom support, and nutrition.
Diagnosis And Treatment Of Attention Defect Hyperactivity Disorder (ADHD)Arwa H. Al-Onayzan
ADHD is diagnosed through clinical history, examination, and sometimes investigations. It is characterized by inattention, hyperactivity, and impulsivity. Treatment includes non-pharmacological options like behavior management as well as pharmacological options like stimulant medications which are the first-line treatment.
Introduction to Depressive Disorders in Children and AdolescentsStephen Grcevich, MD
This is the slide set to the lectures I provided to the medical staff of Child and Adolescent Behavioral Health in Canton, OH during the Fall-Winter of 2018
The document discusses oppositional defiant disorder (ODD), including its diagnosis, clinical features, course, prognosis, treatment, and relationship to other disruptive behavior disorders like conduct disorder. Some key points include:
- ODD is defined by a pattern of negativistic, hostile, and defiant behaviors toward authority figures. It affects around 8-16% of children.
- It commonly co-occurs with disorders like ADHD, depression, and anxiety. Twin studies suggest it has a genetic component.
- Children with ODD may have elevated levels of adrenal androgens like DHEA and DHEAS compared to controls.
- If left untreated, a minority of cases (around 5%) may
This document discusses Attention Deficit Hyperactivity Disorder (ADHD) and how the diagnostic criteria for ADHD has been updated in the DSM-5 to better characterize ADHD in adults. It notes that ADHD often continues from childhood into adulthood. The document then discusses common clinical histories seen in adults with ADHD, domains of impairment associated with ADHD, and the link between ADHD and addiction, noting people with ADHD are vulnerable to substance abuse to try and self-medicate their symptoms. It emphasizes the importance of treating both ADHD and any co-occurring addictions.
Respond by providing at least two contributions for improving .docxpeggyd2
Respond
by providing at least two contributions for improving or including in their Parent Guide and at least two things that you like about their guide.
NOTE: Positive comment
Main Discussion
ADHD Parent Guide
Attention-deficit/hyperactivity disorder (ADHD) is defined as a chronic neurological disorder characterized by a persistent pattern of inattention and/or hyperactivity/impulsivity. In 2016, it is estimated that 6.1 million or 9.4% of children had a diagnosis of ADHD (
Centers for Disease Control and Prevention
, n.d.). A diagnosis of ADHD can be both confusing and welcomed. Confusing because the details of the diagnosis are unknown but welcomed because the parents and child finally have a “why” for the child’s difficulties. This parent guide will discuss the pathophysiolology, diagnosing, signs/symptoms, treatment options, and other aspects involved in an ADHD diagnosis.
Pathophysiology
Many research studies suggest ADHD may be caused by interactions between genes and environmental or non-genetic factors. Many cases of ADHD have a genetic origin. A child is 50% more likely to have ADHD if their parent was diagnosed with the condition and 25% of the children with ADHD have parents who have met the criteria for a diagnosis of ADHD. Other factors that can contribute to ADHD is substance use, low birth weight, brain injuries and exposure to some environmental toxins.
ADHD is a result of neurotransmitter disease dysfunction, that effect dopamine and norepinephrine. Dopamine has a role in a person's ability to learn and reinforcing trained response to various situations. Dopamine also plays and important role in "working memory"(
Attention-deficit Hyperactivity Disorder
, 2004). Norepinephrine effects a person's alertness and attention. Norepinephrine is activated by novel and important stimuli and are quiescent during sleep.
Environmental factors of ADHD is a result of a toxin such as lead or other nuero-toxic substances that may result in delayed development of the child's brain before, during or birth. Substance abuse is a very common cause of pre- and perinatal factors that may result in ADHD. Exposure of the fetus to alcohol is associated with a reduction in the volume of the prefrontal and temporal cortices, the brain areas involved in regulation of attention and control of impulsivity. (
Attention-deficit Hyperactivity Disorder
, 2004)
Diagnosing ADHD
While there is no single test to diagnosis ADHD, there are ways to obtain an accurate diagnosis.
Who diagnosis ADHD?
There are many health care professionals who are qualified to diagnose ADHD. These professionals include but are not limited to psychiatrist, psychiatric mental health nurse practitioner (PMHNP), licensed master social worker (LMSW), licensed professional counselor (LPC), neurologist, pediatricians, and primary care physicians. If there is a concern that a ch.
Attention deficit hyperactivity disorder (ADHD) begins in childhood and may continue into adulthood, affecting an individual's activities professionally, socially, and within their family. ADHD is characterized by symptoms of inattention, hyperactivity, and impulsiveness. While it is a widely recognized disorder, some professionals still question its validity. ADHD has been linked to changes in the brain regions involved in behavioral inhibition, attention, and neurotransmitter systems. Treatment may include therapy, support at home and school, and stimulant medications which help the functioning of affected brain areas without causing addiction.
ADHD and Addiction: Diagnosis and ManagementJacob Kagan
Presentation by Jacob Kagan MD on the diagnosis and management of ADHD and Substance Abuse Disorders, including epidemiology and comorbid conditions,
causality and functional impact, potential explanations for the ADHD/SUD association,stimulant treatment and the risk for SUDs, diversion and misuse of stimulant medications, and treatment recommendations. http://jacobkaganmd.com
Association Between Adult ADHD Symptoms and Family DistressTejas Shah
In this seminar, I will be exploring some research studies discussing how the ADHD symptoms manifest in adults and cause problems and impairment in different domains, ex. home, work, social and personal, of an Adult ADHD person’s life leading to family distress. Further, I will discuss about assessment and management of family distress.
Identifying and Handling Children with DisabilitiesFebby Kirstin
The document discusses several mental health disorders that can affect children, including prevalence, risk factors, symptoms, diagnosis, and treatment. It notes that ADHD is the most common diagnosis, affecting 6.8% of children aged 3-17. Boys are more likely than girls to be diagnosed with certain disorders such as ADHD, autism spectrum disorders, and conduct disorders. Common neurodevelopmental disorders discussed include autism spectrum disorder, intellectual disability, and ADHD. Depression affects 8% of youth aged 12-17, with girls more likely to be diagnosed in adolescence. Anxiety disorders like separation anxiety and social anxiety also affect many children. Assessments involve evaluating symptoms, impairments, and risks according to the DSM-
Oppositional Defiant Disorder (ODD) is characterized by a pattern of negativistic, hostile, and defiant behavior lasting at least 6 months. Treatments include psychotherapy, group therapy, and family therapy to teach parents behavioral techniques. Symptoms include arguing, defiance, annoyance, blaming others, and anger. ODD affects 20% of school-aged children and is more common in boys before puberty. It is caused by biological, psychological, and social factors, and 60% of children with ODD develop Conduct Disorder. Research studies test medication and examine characteristics associated with ODD, CD, and their combination. Parents of children with ODD experience stress, arguments, and strain on the family. Seeking help from
Attention Deficit Hyperactivity Disorder (ADHD) & Latest Research Findings -...manojpradeep21
ADHD is one of the most common neurodevelopmental disorders of childhood that is characterized by inattention, hyperactivity, and impulsivity. It is caused by abnormalities in dopamine neurotransmission in the brain. The symptoms must be present before age 7 and in multiple environments. It is diagnosed through clinical interviews and behavioral rating scales. Treatments include behavioral therapy, medication, and accommodations to help those with ADHD function better. ADHD often persists into adulthood if not properly treated as a child.
ADHD is a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. It affects 3-7% of school-aged children, with boys being affected 4-9 times more than girls. Genetics play a role in about 75% of cases. Symptoms include difficulty paying attention, hyperactivity, and impulsivity. The first line treatment is stimulant medication along with behavioral therapies to help children develop routines and skills to manage their behavior. Nursing care involves ensuring a safe environment and adequate supervision to prevent injury due to impulsive behaviors.
Understand Clients Mental Health Diagnosis & Appropriately Interact with themuyvillage
Definition of mental illness. The causes of mental illness. Tips on how to empower youth with mental health disorders. Ways to teach skills to youth who have the following diagnosis: Reactive Attachment, Post Traumatic Stress Disorder, Oppositional Defiant Disorder, ADHD, Spectrum Disorders,
Briefly share with the class the issue analysis paper written in .docxMikeEly930
Briefly share with the class the issue analysis paper written in week 4 attached. Share one recommendation that you made for solving the problem.
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Briefly share with the class the issue you wrote about in your Week 4 Issue Analysis and Application Paper. Also share
at least one recommendation you made for solving the problem you identified.
Describe three things you learned from the course that you will want to remember 5 years from now. These can be ideas, concepts, techniques, etc. that you think are memorable and will be useful in the future. This portion of the forum calls for you to reflect on what in the course was meaningful to you, and to articulate this beyond a list or summary of textbook chapter ideas.
Adult aging psychology is the course
Childhood conduct problems and adult criminality
Part I, Issue Analysis
This paper will focus on childhood conduct problems and adult criminality. In the paper
deficit disorders with or without hyperactivity (ADHD)
will be analyzed and how it causes criminal activity in adulthood.
According to past research, adult males are more affected by the ADHD compared to adult women. This paper will help us understand why this is the case. It is not in all cases that a child diagnosed with ADHD will be a criminal, but the occurrence rate of ADHD patients being criminals is considerably high. About 50% of children with the disorder ends up committing serious activities of crime and widens records of arrest.
Attention Deficit Disorders With or Without Hyperactivity (ADHD)
When a person has low
brain dysfunctions
or unusual cerebral structures he/she may experience explosive rage periods that may cause violent episodes, hence violent crimes. It is these brain dysfunctions that are diagnosed as ADHD that causes antisocial behavior. It is very common to find ADHD levels among criminal justice system offenders. About 25% of inmates in prison are diagnosed with ADHD with about 70% percent of prisoners exhibiting a considerable level of ADHD symptoms. Further, there is an association of ADHD with other conditions that increases levels of offending, including deficits in neuropsychological, low cognitive and academic skills, psychological problems, defiance and aggression and also truancy.
ADHD Characteristic Traits
A child with ADHD will have concentration problems, hyperactivity and will be impulsive. The child will not be able to sit still, control his/her behavior,
will have problems with
concentration. ADHD is classified into three
cat
e
gories
: Type one is called predominantly inattentive type. Children with this disorder
show difficulty
with focusing on school work, being organized, keeping track and paying attention. The second type is called the hyperactive-inattentive. Children with this type of disorder tend to twitch and squirm,
d
o not manage to.
The Effect of a Brain Training Game on ADD7 FINALJasmine Jensen
The document summarizes research on using brain training games to help improve attention symptoms for those with ADD/ADHD. It discusses how brain training games have been found to increase cognitive performance in the specific tasks trained but not generalize to overall cognitive ability. The study described in the document had subjects with ADD/ADHD do a brain training regimen and their pre and post attention scores on the Stroop test were compared, finding no significant results but marginal significance indicating more subjects may find higher significance. Limitations and possibilities for future research are also discussed.
ADHD is a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. It affects about 5% of children and 2.5% of adults globally. Genetics play a major role in causation, with heritability estimated around 75-80%. Neuroimaging studies show decreased prefrontal cortex volume and activity. Stimulant medications and behavioral therapies are effective treatments. Left untreated, individuals with ADHD are at higher risk for academic underachievement, accidents, substance abuse, and legal/occupational problems.
AD/HD is a disorder that affects about 5% of the population. It involves problems with attention, hyperactivity, and impulsivity. It is diagnosed when a minimum number of symptoms persist for at least 6 months and interfere with daily life. AD/HD has no single presentation, and involves different combinations and severities of inattentiveness, hyperactivity, and impulsivity. It is often first recognized during school years when symptoms interfere with learning, but is not outgrown and can lead to other issues if left untreated. Effective therapies involving medication, psychotherapy, or both can help people manage AD/HD.
Understanding DMDDTreating kids with protracted anger outbursts and irritabi...Stephen Grcevich, MD
Learning Objectives:
Examine why DMDD was established as a stand-alone diagnosis in DSM-5, review the diagnostic criteria for DMDD, along with the differential diagnosis from other common conditions and explore what we know about treating kids with DMDD
The term ADHD refers to Attention Deficit Hyperactivity Disorder, a condition that makes it difficult for children to pay attention and/or control their behavior. Learn more about about the causes, diagnosis and treatment of ADHD.
ADHD is a developmental disorder characterized by inattention, hyperactivity, and impulsivity. It affects 8-12% of school-aged children. While the specific causes are unknown, genetics and environmental factors during pregnancy are thought to play a role. Symptoms include difficulty paying attention, excessive movement, and acting without thinking. Treatment involves behavioral therapy, lifestyle changes, and sometimes medication to manage symptoms.
This document provides information about ADHD (Attention Deficit Hyperactivity Disorder) in the classroom setting. It discusses what ADHD is, common characteristics and symptoms, and effective classroom strategies for students with ADHD such as class-wide peer tutoring and daily report cards. It also emphasizes the importance of communication between teachers and parents.
This document summarizes research on the relationship between diet and Attention Deficit Hyperactivity Disorder (ADHD). It discusses several studies that have investigated eliminating certain foods like artificial dyes, sugars, or common allergens from children's diets to see if it reduces ADHD symptoms. The research has found that diet changes can significantly improve symptoms for a small subset of children with ADHD, possibly due to food sensitivities. However, results have been inconsistent. More research is still needed to better understand how diet may help manage ADHD symptoms for some individuals.
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share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
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- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
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Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
2. Efforts to Usefully Subtype ADHD
DSM-IV has proven to be relatively useless except for
the Inattentive Type in which a subset of cases appear
to have Sluggish Cognitive Tempo (SCT)
Using etiology (acquired vs. familial) may eventually be
useful but as yet is not well-researched
Acquired cases can arise at any time, though often result from
pregnancy factors
Acquired cases may not respond to stimulants as well as familial cases
Molecular genetics may eventually offer ways of creating
more homogeneous clinically useful subsets
Certain gene variants may predict drug and behavioral treatment
response as well as adverse life course risks
Comorbidity offers the most useful and best established
means for deriving clinically useful subtypes currently*
*Ostrander, R. (2008). Journal of Clinical Child and Adolescent Psychology, 37(4), 833-847.
3. Oppositional Defiant Disorder (40-80%)
A pattern of hostility, anger, defiance, stubbornness,
low frustration tolerance and resistance to authority
(usually parental)
Comprises a two-dimensional disorder
Social conflict and emotion dysregulation*
ADHD cases are 11x more likely to have ODD**
ADHD contributes to and likely causes ODD
This likely occurs through the impact of the hyperactive-
impulsive dimension of ADHD and its strong association
with emotional dysregulation (executive dysfunction)***
This can account for the well-established findings that
ADHD medications reduce ODD symptoms nearly as much
as they do ADHD symptoms
*Hoffenaar, P. J. & Hoeksma, J. B. (2002). Journal of Child Psychology and Psychiatry, 43(3), 375-385.
** Angold, A. et al. (1999). Journal of Child Psychology and Psychiatry, 40, 57-88.
***Burns, G. L. & Walsh, J. A. (2002). Journal of Abnormal Child Psychology, 30(3), 245-256.
4. More on ODD
Some variance in ODD severity is also related to
disrupted parenting
Inconsistent, indiscriminate, emotional, and episodically vacillating
between harsh and permissive (lax) consequences teaches social
coercion as a means of social interaction.
But timid parenting is the most important factor contributing to
ODD which feeds back to make parents more reluctant to discipline
Poor parenting can partly arise from parental ADHD and other high
risk parental disorders in ADHD families (e.g., depression, ASP,
SUDS)
Early ODD predicts persistence of ADHD and
increases risk for enuresis, CD/MDD and anxiety
Emotional dysregulation component predicts later MDD; conflict
component predicts later CD
5. 4-Factor Model of Defiance
Parental
Psychopathology
Child ODD:
Disrupted Parenting Social Conflict
Anger-Frustration
Family Stressors
Child Factors:
Negative Temperament
ADHD Emotional Dysregulation
Mood Disorder
6. Treatment Impact of ODD
Both stimulants and ATX reduce it when it is comorbid with
ADHD; not when ODD is alone
Higher doses may be needed for comorbid cases
Requires adjunctive parent training in behavior
management methods; response is age-related:
60-75% successful for children; 25-35% treatment response after 13+ yrs.
of age
May need to treat parent’s ADHD first to succeed
May need to add problem-solving communication training of teen and
parents after age 14 years
Severely explosive anger may be a sign of either childhood
Severe Mood Dysregulation (SMD) or Bipolar Disorder (BPD)
Treat SMD with stimulants or other ADHD medications first along with
behavior modification methods. If needed, employ antihypertensives or, as
a last resort, atypical antipsychotics. Mood stabilizers have not been found
to be useful for SMD (or even childhood BPD*
*Child and adolescent psychopharmacology news, Vol. 14 (6), 2009
7. Conduct Disorder (20-56%)
If starts early, represents a more severe disorder
and possibly a unique family subtype
More severe, more persistent antisocial behavior
Worse family psychopathology
Antisocial personality, substance use disorders, major depression
Parent hostility, depression, & low warmth and monitoring interact
reciprocally with child conduct problems over time to adolescence*
Greater association with ADHD (especially inattention symptoms)
Less responsive to behavioral or family interventions
Increased risk of psychopathy (20%)
Father desertion, parent divorce more common
Major depression more likely to precede/co-exist with CD
* Special issue on reciprocal influence across development, Journal of Abnormal Child Psychology (2008), vol. #36 (July) .
8. Conduct Disorder
One pathway to early onset CD is through ADHD and its
impulsivity perhaps when combined with adverse social
environments*
Explains why most ADHD does not get CD but most early CD cases
have ADHD
School drop out, drug use, and teen pregnancy are more
likely in comorbid cases than in ADHD alone**
ODD is not so much a precursor to or predictor of CD
but develops in parallel with it if CD has an early onset.
If CD starts late (>12), it may be related to social
disadvantage, family disruption, & affiliation with deviant
peers. BUT, recent research shows reduced amygdala
and insula volume in both CD types*** so some
neurobiological factors are involved in late onset CD too.
*Beauchaine, T. et al. (2010). Clinical Psychology: Science and Practice, 17, 327-336.
**Barkley, R. A. et al. (2008). ADHD in Adults: What the Science Says. New York: Guilford.
*** Fairchild, G. et al. (2011). American Journal of Psychiatry, 168, 624-633.
9. Treatment Impact of CD
Stimulants and ATX reduce aggressive behavior and antisocial acts but
stimulants may work more rapidly to gain case control
Higher doses often required in comorbid cases
Stimulant effectiveness may deteriorate with duration of treatment (3+ yrs)
in this subset of ADHD cases (MTA study)
Parent and family interventions often required to address family issues
Problem-solving, communication training and parent BMT
Multi-systemic therapy where available
Treatment of parental depression and other psychiatric disorders
Family relocation to better neighborhoods advisable
If psychopathy (callous-unemotional traits) is present there is limited or
no response to behavior therapy alone – medication is necessary first,
then follow up with behavioral treatments*
Avoid group treatment due to deviancy training by aggressive peers
Involvement of social service and juvenile justice agencies is highly
likely – educate them about comorbidity
As in ODD, treat with ADHD medications and behavior modification
first. Then follow-up with antihypertensives or, rarely, atypicals may be
needed for highly aggressive/explosive cases or BPD. Mood stabilizers
are often unhelpful.
*Waschbusch, D. A. et al. (2007). Journal of Clinical Child and Adolescent Psychology, 36(4), 629-644.
10. Anxiety Disorders (10-40%)
Considered a stealth or hidden comorbidity in child ADHD cases if only
parents are interviewed about child anxiety symptoms.
High comorbidity with adult ADHD (30%+)
Related in part to emotional dysregulation in ADHD (& ODD)
This is evident more as negative affectivity rather than fear/worry
Also risk for real anxiety disorders(risk increases with age)
Most common are simple phobias or separation anxiety in early
childhood; GAD becomes more common with age
Risk is related to:
earlier inattention more than to impulsive-hyperactive symptoms*
greater disruptive and stressful life events
presence of autistic spectrum disorders and chronic multiple tics**
parental anxiety disorders
Comorbid cases often show lower levels of impulsiveness but are still
more impaired than ADHD alone cases
Comorbid cases have more sleep problems (bedtime resistance and
night waking); anxiety contributes to these besides ADHD
Anxiety contributes additionally to social impairment besides ADHD
*Reinke, W., & Ostrander, R. (2008). Journal of Abnormal Child Psychology, 36(7), 1109-1122.
** Gadow, K. et al. (2009). Journal of Attention Disorders, 12(5), 474-485.
11. Role of Parent Anxiety Disorders
Anxiety disorders more likely in parents and
family* (18%+ of parents have significant
symptoms of anxiety or depression)**
Child and parental anxiety are associated with
low rates of positive parental behavior, over-
protectiveness of the child, less autonomy for
the child, lower child self-sufficiency, and parent
modeling of anxiety.
This excess parental control may increase child
perceptions of threat, decrease children’s sense
of controlling threats, and decreased opportunity
for experience with managing threats***
*Pfiffner, L. & McBurnett, K. (2006). Journal of Abnormal Child Psychology, 34, 725-735.
*Kepley, H., & Ostrander, R. (2007). Journal of Attention Disorders, 10, 317-323.
** Vidair et al. (2011). J Amer. Acad. Child. Adolesc. Psychiatry, 50(5), 441-450.
*** van der Bruggen, C. O. et al. (2008). (meta-analysis) Journal of Child Psychology
and Psychiatry, 49(12), 1257-1269.
12. Treatment Impact of Anxiety Disorders
Probe more carefully in child cases for child
physical or sexual abuse or bullying at school
Bully-victims have high rates of psychosomatic symptoms*
More responsive to behavioral therapies (MTA Study)
May respond better to social skills training (and
possibly cognitive-behavioral therapies)
But CBT outcomes are poor if parental anxiety remains high and if
paternal rejection and depression are present**
Family counseling may be required to limit family
induction of anxiety by other anxious members
Focus parent BMT on increasing positive parenting
behavior and reducing over-protectiveness and less
so on parent discipline tactics
*Gini, G. & Pozzoli, T. (2009). Pediatrics , 123(3), 1059-1065.
**Liber, J. et al. (2008). Journal of Clinical Child and Adolescent Psychology, 37(4), 747-758.
13. Impact of Anxiety on Med Management
Anxiety (or high internalizing symptoms) has
been associated in some studies with reduced
response to stimulants. 4 issues arise here:
Do stimulants make ADHD worse in mixed cases? No
Do stimulants result in less improvement in ADHD
symptoms in these comorbid cases? Maybe –
findings are conflicting here*
Do stimulants make anxiety worse? Maybe – results
are conflicting here also
Do stimulants make some cognitive abilities worse in
mixed cases? Probably**
*Pliszka, S. (1989). Journal of the American Academy of Child and Adolescent Psychiatry, 28, 882-887. Biutelaar, J. et
al. (1995). Journal of the American Academy of Child and Adolescent Psychiatry, 34, 1025-1032. Abikoff, H. et al.
(2005). Journal of the American Academy of Child and Adolescent Psychiatry, 44(5), 418-427. Pliszka, S. (2003).
Paediatric Drugs, 5(11), 741-750.
**Blouin, B. et al. (2009). Journal of Attention Disorders, 13(4), 414-419. Pliszka, S. (1989) [see above]. Tannock, R.
et al. (1995). Journal of the American Academy of Child and Adolescent Psychiatry, 34 , 886-889. Bedard, A. &
Tannock, R. (2008). Journal of Attention Disorders, 11(5), 546-557.
14. More Impact of Anxiety on Med Mgmt
Atomoxetine (ATX) and guanfacine XR do
not worsen anxiety in comorbid cases.
AACAP and CADDRA Practice Guidelines
recommend both stimulants and ATX as
first choice treatments in comorbid cases
15. Major Depression (0-45%)
Likely genetic linkage to ADHD
Genes create a vulnerability to MDD
MDD expressed upon exposure to repeated social
and emotional distress, physical trauma, etc.
Also related to presence of earlier ODD and CD in
child or adult patient & family
Often manifest low self-esteem in childhood in
contrast to other ADHD cases
Full MDD onset may not be until adolescence or
later
In adults with ADHD, MDD is related to higher GAD
and social phobia but lower SUDS and school
disciplinary actions and grade repetitions in
history*
*Fischer, A. et al. (2007). Journal of Psychiatric Research, 41, 991-996.
16. More on Impact of MDD
Parental depression is elevated in these child cases
(18%+ have elevated depression or anxiety)*
Depressed parents:
show decreased positive parenting and nurturance, greater
irritability and expressed emotion, irritability and open hostility,
erratic use of discipline tactics, child rejection, and poor child
monitoring – these are associated with increased later risk for
child ODD and also internalizing problems**
Parental MDD linked directly to child ODD risk; parental DBD
with MDD increases risk for child ADHD, CD, and mania***
Evaluate carefully for presence of child physical or sexual
abuse or victimization by bullying in child cases
Increased suicidal ideation (4x) and attempts (2x) in
ADHD cases during peak risk years in high school
* Vidair et al. (2011). J Amer. Acad. Child. Adolesc. Psychiatry, 50(5), 441-450.
**Elgar et al. (2007). Journal of Abnormal Child Psychology, 35, 943-955.
**Gerdes, et al. (2007). Journal of Abnormal Child Psychology, 35, 705-714.
*** Hirshfeld-Becker, D. R. et al. (2008). Journal of Affective Disorders, 111, 176-184.
17. Suicidality in Childhood
Follow-up study of 127 ADHD cases from age 8
to 14 years*
8 have seriously considered suicide (6.3%)
One teen went on to try once, but was not treated ; one went on to try
more that once and was treated. The latter teen had self-harmed 5
times.
10 teens had intentionally injured themselves
(7.9%) (self-cutting, etc. 1-6x over 1 year); 5 of
these cases had considered or attempted suicide
• R. Schachar, M.D., Hospital for Sick Children (2009, personal communication)
18. Suicidality in Teens & Adults
ADHD is associated with a greater risk for suicidal
ideation & attempts*
Ideation in high school (33 vs. 22%)
Attempts in high school (16 vs. 3%)
Attempts are worse (46% vs. 11% hospitalized)
Ideation after high school (25% vs. 12%), attempts 6 vs
3%); risks for ideation found even at age 27
Associated with comorbid MDD (4x), CD (somewhat), and
more severe ADHD
Evaluate carefully for child physical or sexual abuse or
victimization by bullying
*Barkley, R. A. & Fischer, M. (2005). The ADHD Report, 13 (6), 1-4.
*Barkley, R. A., Murphy, K. R., & Fischer, M. (2008). ADHD in adults: What the
science says. New York:Guilford
19. Treatment Impact of MDD
Use ADHD drug first if:
ADHD is chief complaint
ADHD symptoms are more disabling
MDD is mild: Little or no current functional impairment
from depression; dysthymia or demoralization are present
Neuro-vegetative signs are mild or absent
ADHD symptoms clearly preceded MDD symptoms
Start with Antidepressant first if:
MDD symptoms are chief present complaint
Prominent neuro-vegetative signs or health is compromised
Present of suicidal ideation
ADHD symptoms are mild, have a late onset, or are
coincident with MDD onset.
Clear history that depression was non-responsive to ADHD
drugs
20. More Impact of MDD
May require mixed ADHD/SSRI therapy
Stimulants and atomoxetine do not treat MDD
May need cognitive-behavioral therapy
Assess for parental induction of depression in
children and exaggeration of child ODD symptoms
given higher maternal depression
Parent depression may require separate treatment
In parent training use a “go slow” approach to
punishment so as not to contribute to depressive
cognitive schemas (self-statements) or to already
excessive parental use of criticism and discipline
start with all reward programs initially until MDD
symptoms lift then introduce mild, selective punishments.
21. Child Bipolar Disorder (BPD) (2-6%)
Overlap with ADHD is controversial (2-27% incidence in
ADHD cases across studies)
Prevalence rates differ: ADHD = 5-8%, BPD = 1.2-1.6%
Comorbidity can arise from several problems with DSM
Some cases are misdiagnosed BPD when they are ADHD/ODD
ADHD symptoms overlap with bipolar symptoms in DSM
Irritability could substitute for mania in children in DSM-IV – this is
an error to be corrected in DSM-5 (could be ODD)
No requirement for cycling or periods of remission in children
DSM-V will likely require mixed moods (bipolarity), cycling between
them, grandiosity, mania and other typical cognitive BPD symptoms
SMD is more likely to co-exist with ADHD – irritability with
explosive/aggressive behavior but no mania
Overlap probably represents a one-way comorbidity
2-6% of ADHD cases have BPD; 80-97% of child BPD have ADHD
but only 15-20% of adult onset BPD cases have ADHD.
22. More on BPD
Risk for BPD is not elevated in follow-up studies of ADHD
kids (2-6%) or in studies of clinic referred ADHD adults1,2
Childhood BPD has 7-8x family risk of BPD than does ADHD
or adult onset BPD; BPD not elevated in ADHD families
Parental BPD associated with 8x greater risk for ADHD in
offspring and for subthreshold mood and manic symptoms3
BPD unlikely to be fully evident before age 10 years but can
be prodromal in offspring of BPD adults, especially if ADHD
and ODD develop3
Sequence: Age 4 (hyper); 6 (ADHD), 12-22 (BPD+ADHD); adulthood (BPD,
less ADHD)
Neuro-imaging results differ between ADHD and BPD
Larger caudate in BPD; smaller in ADHD
Anterior cingulate affected in both but subgenua ventral region more
involved in BPD while dorsal ACC is less active in ADHD
1. Barkley, R. A. (2006). Attention deficit hyperactivity disorder: A handbook for diagnosis and treatment (3rd
ed.). New York: Guilford Press.
2. Barkley, R. A. et a. (2008). ADHD in adults: What the science says. New York: Guilford Press.
3. Birmaher, B. et al. (2010). American Journal of Psychiatry, 167(3), 321-330.
23. Differential diagnosis from ADHD
All ADHD symptoms are more severe in BPD cases but ADHD
cases do not show the typical mood regulation features of
BPD. Focus on mood, thought, and hypersexuality.
Irritability: 95% (BPD) vs. 65% (Disruptives)
Elation: 73% vs. 15%
Grandiosity: 80% vs. 10%
Excessive talking: 92% vs. 38%
Racing thoughts: 30% vs. 5%
Flight of ideas: 69% vs. 14%
Decreased need for sleep: 42% vs. 12% (ADHD kids have
sleep problems)
Pressured speech/motor: 84% vs. 35%
More active: 85% vs. 43%
Uninhibited socializing: 32% vs. 3%
Hypersexual: 53% vs. 3%
From Luby & Belden, 2006, Development and Psychopathology, 18, p. 971
24. C-BPD Diagnostic Keys
Grandiosity, elated mood, psychotic-like thinking
(paranoia, delusions, auditory hallucinations, disjointed
thought) , decreased need for sleep and hyper-sexuality
are involved in C-BPD but not in ADHD.
Inattention, high energy, distractibility are NOT helpful signs for
differential diagnosis
Depressed-irritable mood is also a major problem and
moods are often severe (i.e., rage attacks, violence,
destructive). Classify as SMD if mania is absent
Mood states are not related to immediate environmental
events in a rational sense (irrational and inconsistent)
ADHD kids have rational but somewhat excessive emotions
Disruptive (aggressive) behavior rated as 3+SDs on
rating scales like the CBCL (85 or higher) goes with
CBPD, not with ADHD
BPD is significantly more prevalent in biological relatives
25. Treatment Impact of BPD1
Medical management of bipolarity should be done first
before managing ADHD symptoms with ADHD drugs
But expect mania not to be as responsive to BPD drugs
when ADHD is a comorbidity2
Often requires poly-pharmaceutical management for long-
term (mood stabilizers, atypicals, anticonvulsants likely)
Often requires periodic hospitalization for safety (suicidality
or violence) and stabilization
Special education (ED) programs are likely to be needed
SUDs are likely by adolescence (monitor/manage)
Suicidality is increasingly problematic at adolescence
15-20% completed suicide rate
30x population rate for attempts
1. See special issues of Development and Psychopathology, 2006, 18. Entire issue is on childhood BPD,
diagnosis, and management.
2. Consoli et al. (2007). Canadian Journal of Psychiatry, 52(5), 323-328.
26. More Treatment Impact of BPD
Consider all-reward or non-confrontational
parent training programs (Greene &
Ablon’s Explosive Child)
Interventions also must focus on parental
coping with explosive episodes rather than
expecting remediation of disruptive
behavior
ADHD/BPD have highest rates of physical
abuse/PTSD of all ADHD cases
Counsel parents on stress management;
periodic respite care as needed
27. Autistic Spectrum Disorders
20-25% of ADHD children have autistic
spectrum symptoms or disorder
20-54% of ASD kids have ADHD
Overlap may be partially due to risk genes
shared between the two disorders
Both disorders are highly heritability (70-80%)
Poor inhibition is linked to ADHD not to ASD
symptoms while inattention is shared by both
disorders; ASD is more related to social and
language impairments
ADHD medications can be used to treat ADHD
symptoms effectively in context of ASD
28. Learning Disabilities (24-70%)
Not due to ADHD:
Reading (8-39%); (effect size (ES) = 0.64)
Spelling (12-30%) (ES = 0.87)
Math (12-27%) (ES = 0.89)
Result from ADHD or correlated with it
Handwritingproblems (60%+)
Comprehension deficits
Reading, listening, & viewing deficits
Due to adverse impact of ADHD on working
memory
29. Treatment Impact of LDs
Comorbid Reading, Spelling and Math Disorders do
not improve from stimulants
Reading ability improves on atomoxetine
Additional educational interventions will be needed
for these comorbid disorders
Comorbid handwriting and comprehension deficits
are likely to improve from stimulants if secondary to
ADHD itself
ADHD cases with comorbid math disorder may be
less likely to respond to stimulants (37%) than
those with reading disorder (67%) or no LD (75%)*
*Grizenko et al. (2006). Journal of Psychiatry & Neuroscience, 31(1), 46-51.
30. Conclusions
Comorbidity is very common in both child and
adult ADHD
Comorbidity produces additional impairments in
major life activities
Comorbidity affects life course
Comorbidity may require adjustments to ADHD
treatments
Choice of meds is related to presence of anxiety, sleep
problems, tics/TS and OCD, risk for diversion or abuse, and
urgency of care
Comorbid disorders often require separate
interventions from ADHD treatments