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

2. 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

3. 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

4. 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

5. 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)

6. 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)

7. 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

8. 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)

9. 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.

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

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

12. 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.

13. 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.

14. 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

15. 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)

16. 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

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

18. 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.

19. 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

20. 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.