Is ADHD overdiagnosed? 1.Where do you stand on the diagnosis of ADHD – do you think it is overdiagnosed? Why or why not? 2.What factors might lead to overdiagnosis of ADHD? What about underdiagnosis? 3.What problems might result from underdiagnosis or overdiagnosis?

Initial questions/myths to be addressed Is ADHD a relatively new disorder? Are ADHD symptoms fairly common; are we merely labeling normal behavior as a disorder? Is ADHD/inattentive type similar to the traditional combined type? Has the rate of ADHD increased in the last twenty years?

Core Symptoms Inattention OR Impulsivity Hyperactivity (recent DSM change) Central role of impairment Must be present before age 7 Impairment in 2 or more settings

Associated features of ADHD Learning problems Peer problems aggression, noncompliance

Diagnostic Issues Diagnosis based on history of disorder –Rating scales –Interviews –Observations –Best with two sources No medical test or lab measure to determine diagnosis

Prognosis Chronic disorder extending into adulthood 3 common outcomes: –Minimal problems –Some moderate problems –Severe problems

Ineffective Treatments “talk” therapy Play therapy Elimination diets Allergy treatments Chiropractics Pet therapy Dietary supplements Perceptual or motor training/sensory integration training

Effective Treatments Evidence-Based 1.Psychostimulant medications Ritalin (methylphenidate), Dexedrine, Cylert Concerta, Adderall Strattera is new nonstimulant med 2.Behavior therapy

Main Benefits of Meds 2/3 of children show benefits; another 10% benefit from other; rest show no response or adverse response Less classroom disruption Better behavior as rated by teacher More compliant with adult requests Increase in on-task behavior Better peer interactions

Other important points Needs to be long-term Few dysfunctional attributions No increase in risk for later substance abuse Not sufficient

Limitations of drug treatment Rarely sufficient Not effective for all No impact on some family variables Removes incentives for behavioral tx No long-term effects

Adverse Effects Irritability, moodiness Stomaches, headaches Insomnia Loss of appetite – less growth Motor movements, tics Rebound effect

Behavior Modification Only psychosocial tx Should be implemented first Train parents and teachers Extensive Difficult Punishment/response cost needed

Parent Training 1.Establish house rules 2.Praise appropriate behavior 3.Use appropriate commands 4.When…then contingencies 5.Time out 6.Points/token systems 7.Continually evaluate and modify

School Interventions Clear classroom rules Similar to parent stuff Near teacher Focus on academic performance Home report cards

Combined interventions Produce better short-term effects Often preferred by parents