Kristen Hedger Archbold, RN, PhD Assistant Professor University of Arizona College of Nursing Faculty, Pediatric Pulmonary Center

Attention Deficit Disorder (ADD) Attention Deficit Hyperactivity Disorder (ADHD) Definitions Prevalence Treatment ADD & ADHD Issues for special populations Asthma Cystic Fibrosis Chronic Illness Sleep Disorders

Attention Deficit Disorder (ADD) (disclaimer)  Most commonly referred to as Attention Deficit/Hyperactivity Disorder, Inattentive type  Has characteristics of ADHD, but without motor movement patterns.  For this talk, we will discuss ADHD in a very general sense that encompasses the full spectrum of the disorder

Attention Deficit/Hyperactivity Disorder (ADHD)  Prevalence estimates 3-7% of school-aged children (American Psychological Association, 2000)  Studies report prevalence of 9-12% with a higher prevalence rate in boys, nearly 2-to-1  Persists into adulthood in majority of cases

ADHD: Societal costs in dollars  Estimated annual cost per individual: $14,576 (2005 U.S. dollars)  Both adults and children with ADHD have higher medical costs in general ($1500 per child, $3000 per adult)  Household incomes in adults with ADHD are significantly lower regardless of academic achievement. (Pelham, Foster & Robb, 2007; Matza, Paramore & Prasad, 2005; Biederman & Faraone, 2006)

ADHD: Social consequences  Parents of ADHD children Increased self-blame Social isolation Depression Marital discord  Employment status of parents is negatively affected. (Johnston & Mash, 2001; American Psychological Association, 2000)

ADHD: Definitions  Diagnostic and Statistical Manual of Mental Disorders – 4 th Edition, Text Revision (DSM- IV-TR)  Really is not one universal pattern of symptoms  Symptoms vary across lifespan

ADHD: cluster of symptoms  Symptom cluster that MUST be present: 6 of 9 symptoms of inattention (i.e., does not listen when spoken to, easily distracted by extraneous stimuli) 6 of 9 symptoms of Hyperactivity/Impulsivity (i.e., constantly on the go, leaves seat in classroom) Inattentive type, Hyperactive/Impulsive type and Combined type (majority)

ADHD: diagnosis  Based on presence of symptoms 6 months or more before age 7 Not Otherwise Specified: symptoms don’t fit entirely into specified categories.

ADHD: Underdiagnosis  Commonly underdiagnosed African American Low socioeconomic status Female children  Psychiatric comorbidity Depression Substance Abuse Disorder Bipolar Disorder, Anxiety

ADHD: Screening tool  Pediatric Symptom Checklist (Jellinek et al., 1988)  Use in conjunction with interview by care provider  Formal diagnosis made by clinical specialists.

ADHD: Preschool aged child  Difficult to diagnose  Symptoms may differ Non-compliance in social settings/school Dislike by other children Demanding Behaviors  Core symptoms of motor activity, frustration intolerance, impulsivity and distractibility are present.

ADHD: Overall Treatment  American Academy of Pediatrics (2001) recommended a thorough plan for treatment  ADHD is a chronic condition  Follow-up in systematic manner  Target outcomes (behavioral, cognitive) are specified and worked towards.

ADHD: Treatment Nonpharmacologic  Cognitive Behavior Therapy (CBT) with ADHD adults, not effective with children  Summer camps, special classrooms, consistent rewards and punishments  Clinical behavior therapy Work with parents, teachers to modify home and school environments to support the child 10 to 20 sessions of about 90 minutes each

ADHD: Clinical behavioral therapy  ADHD education  Attend carefully to child’s behavior and respond consistently, appropriately  Daily school report card  Token reward system  Effective use of time-outs (Plizka, 2007; Smith et al., 2006)

ADHD: Pharmacological treatment  Stimulant medications Ritalin Methamphetamine Adderal (only one approved for age 3 and older)  Non-stimulant medication Atamoxetine Side effects: decreased appetite, headache, insomnia

ADHD: Pharmacological treatment  Tricyclic antidepressants (TCA) Buproprion  Alpha Agonists  Combination therapy, complex treatment algorithm

ADHD: Co-morbidities  Can co-exist with any medical condition  Stigmas associated with medication use (African American) and mental illness (Hispanic) have been reported, therapies must be designed with cultural appropriateness.

ADHD: Individualized Education Program (IEP)  Created in 2006  Parents, school staff work together to develop a plan for each ADHD patient Focus on goals to be achieved Accommodations necessary in classroom How progress will be measured

ADHD: Section 504  1973 Rehabilitation Act  A plan is developed Assistive technology Extra time for completion of assignments  Parents must be educated on which plan is better for their child, criteria may vary state-to state  Plans MUST be individualized for each child’s needs.