Developmental Disorders Chapter 13

Attention Deficit Hyperactivity Disorder (ADHD): An Overview Nature of ADHD Central features – Inattention, overactivity, and impulsivity Associated with behavioral, cognitive, social, and academic problems DSM-IV and DSM-IV-TR Symptom Clusters Cluster 1 – Symptoms of inattention (Inattentive Subtype) Cluster 2 – Symptoms of hyperactivity and impulsivity cluster – (Hyperactive/Impulsive Subtype) Either cluster 1 or 2 must be present for a diagnosis Can be combined subtype (inattentive & hyperact/impul)

ADHD: Facts and Statistics Prevalence Occurs in 4%-12% of children who are 6 to 12 years of age Symptoms are usually present around age 3 or 4 68% of children with ADHD have problems as adults Gender Differences Boys outnumber girls 4 to 1

ADHD Etiology Genetic heritability is very high (.80+) Neurological dysfunction Cormorbidity with learning disorders, conduct problems Overall smaller brain volume (frontal cortex, basal ganglia, cerebellar vermis) No evidence of food colors, preservatives as causal Maternal smoking during pregnancy is risk factor More negative interaction patterns with parents and teachers appear to be result of ADHD, not cause Probability of ADHD diagnosis is greatest in the United States

ADHD Treatment Biological treatment through stimulant medication Ritalin or Concerta (methylphenidate), Cylert (pemoline) and Dexedrine (D-amphetamine), Adderall Non-stimulant – Straterra Medication effects directly target poor attention & concentration (most effective method), but do not target social problems Side effects a concern, but with careful monitoring can be minimized Approximately 25-30% do not respond to medication

ADHD Treatment (cont’d) Psychological Treatment Behavior Therapy – parent training, contingency management at home and in school, social skills training, problem-solving, anger control Coordination of treatment at home & school works best Behavior therapy has the best effect on reducing inappropriate behaviors, improving social functioning, improving academic functioning (in short-term) Combination Treatments MTA study – 5 sites over 5 years compared medication alone, BT alone, and combination treatment Best outcome on the widest number of areas is with combination treatments (but medication had best specific effect on increasing attention)

Learning Disorders: An Overview Scope of Learning Disorders Problems related to academic performance in reading, mathematics, and writing Performance is substantially below what would be expected based on cognitive ability DSM-IV and DSM-IV-TR Reading Disorder Discrepancy between actual and expected reading achievement Reading is at a level significantly below that of a typical person of the same age Problem cannot be caused by sensory deficits (e.g., poor vision) Although may learn to read, fluency and comprehension may still not be at expected level

Learning Disorders: An Overview (cont.) DSM-IV and DSM-IV-TR Mathematics Disorder Achievement below expected performance in mathematics DSM-IV and DSM-IV-TR Disorder of Written Expression Achievement below expected performance in writing

Learning Disorders: Some Facts and Statistics Incidence and Prevalence of Learning Disorders 1% to 3% incidence of learning disorders in the United States Prevalence is highest in wealthier regions of the United States Prevalence rate is 10% to 15% among school age children Reading difficulties are the most common of the learning disorders About 32% of students with learning disabilities drop out of school School experience for such persons tends to be quite negative

Causes of Learning Disorders Genetic Component Concordance rate among identical twins almost 100% Chromosome 6 and 15 Neurological deficits – complex, varied High comorbidity with ADHD, but distinct 30-50% of those with ADHD have at least 1 learning disorder 30-50% of those with a learning disorder have ADHD

Treatment of Learning Disorders Requires Intense Educational Interventions Remediation of basic processing problems (e.g., teaching visual skills) Improvement of cognitive skills (e.g., instruction in listening) Targeting behavioral skills to compensate for problem areas Data Support Behavioral Educational Interventions for Learning Disorders Americans with Disabilities Act and Rehabilitation Act require reasonable accommodations for students with disabilities to ensure equal access to education

2.04 Objective criteria for diagnosis of a "specific learning disability" have yet to be succinctly defined by educational psychologists. OSU embraces the general guidelines suggested by the Oklahoma State Regents for Higher Education in 1991, which acknowledge that while multiple approaches are used in this area, specific criteria for diagnosis of a learning disability include: average to above average intellectual ability; severe processing deficits; severe aptitude achievement discrepancies, despite adequate learning opportunities; and a condition of presumed neurological origin. - OSU's Policies and Procedures in regard to Academic Accommodations for Students with Disabilities