MH133.pdf

11/27/23, 3:51 AM Realizeit for Student Attention-Deficit/Hyperactivity Disorder Attention-deficit/hyperactivity disorder (ADHD) is characterized by inattentiveness, overactivity, and impulsiveness. ADHD is a common disorder, especially in boys, and probably accounts for more child mental health r...

11/27/23, 3:51 AM Realizeit for Student Attention-Deficit/Hyperactivity Disorder Attention-deficit/hyperactivity disorder (ADHD) is characterized by inattentiveness, overactivity, and impulsiveness. ADHD is a common disorder, especially in boys, and probably accounts for more child mental health referrals than any other single disorder. The essential feature of ADHD is a persistent pattern of inattention and/or hyperactivity and impulsivity more common than generally observed in children of the same age. ADHD affects 5% to 8% of school-aged children, with 60% to 85% having symptoms persisting into adolescence. Up to 60% continue to be symptomatic into adulthood. The ratio of boys to girls ranges from 2:1 in nonclinical settings to 9:1 in clinical settings (Spaniardi, Greenhil, & Hectman, 2017). To avoid overdiagnosis of ADHD, a qualified specialist, such as a pediatric neurologist or a child psychiatrist, must conduct the evaluation for ADHD. Children who are very active or hard to handle in the classroom can be diagnosed and treated mistakenly for ADHD. Some of these overly active children may suffer from psychosocial stressors at home, inadequate parenting, or other psychiatric disorders. It is essential to have a thorough and accurate diagnosis for ADHD. There are other disorders and situations that may look similar to ADHD, such as bipolar disorder or behavioral acting out in response to family stress, such as divorce, parental mental disorders, and so forth. A key feature of ADHD is the consistency of the child’s behavior—every day, in almost all situations, and with almost all caregivers, the child demonstrates the problematic behaviors. Distinguishing bipolar disorder from ADHD can be difficult but is crucial to prescribe the most effective treatment. Onset and Clinical Course ADHD is usually identified and diagnosed when the child begins preschool or school, though many parents report problems from a much younger age. As infants, children with ADHD are often fussy and temperamental and have poor sleeping patterns. Toddlers may be described as “always on the go” and “into everything,” at times dismantling toys and cribs. They dart back and forth, jump and climb on furniture, run through the house, and cannot tolerate sedentary activities such as listening to stories. At this point in a child’s development, it can be difficult for parents to distinguish normal active behavior from excessive hyperactive behavior. By the time the child starts school, symptoms of ADHD begin to interfere significantly with behavior and performance. The child fidgets constantly, is in and out of assigned seats, and makes excessive noise by tapping or playing with pencils or other objects. Normal environmental noises, such as someone coughing, distract the child. He or she cannot listen to directions or complete tasks. The child interrupts and blurts out answers before questions are completed. Academic performance suffers because the child makes hurried, careless mistakes in schoolwork, often loses or forgets https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2ITzAkY3nMIj7MBSgsqXE3qy7jjixvejaRv7GnkF88dMM%… 1/10 11/27/23, 3:51 AM Realizeit for Student homework assignments, and fails to follow directions (Zendarski, Sciberras, Mensah, & Hiscock, 2017). Socially, peers may ostracize or even ridicule the child for his or her behavior. Forming positive peer relationships is difficult because the child cannot play cooperatively or take turns and constantly interrupts others. Studies have shown that both teachers and peers perceive children with ADHD as more aggressive, bossier, and less likable (Grygiel, Humenny, Rebisz, Bajcar, & S´witaj, 2018). This perception results from the child’s impulsivity, inability to share or take turns, tendency to interrupt, and failure to listen to and follow directions. Thus, peers and teachers may exclude the child from activities and play, may refuse to socialize with the child, and/or may respond to the child in a harsh, punitive, or rejecting manner. Approximately 60% to 85% of children diagnosed with ADHD continue to have problems in adolescence. Typical impulsive behaviors include cutting class, getting speeding tickets, failing to maintain interpersonal relationships, and adopting risk-taking behaviors, such as using drugs or alcohol, engaging in sexual promiscuity, fighting, and violating curfew. Many adolescents with ADHD have discipline problems serious enough to warrant suspension or expulsion from high school. The secondary complications of ADHD, such as low self-esteem and peer rejection, continue to pose serious problems. Previously, it was believed that children outgrew ADHD, but it is now known that ADHD can persist into adulthood. Estimates are that 60% of children with ADHD have symptoms that continue into adulthood. In one study, adults who had been treated for hyperactivity 25 years earlier were three to four times more likely than their brothers to experience nervousness, restlessness, depression, lack of friends, and low frustration tolerance. Approximately 70% to 75% of adults with ADHD have at least one coexisting psychiatric diagnosis, with social phobia, bipolar disorder, major depression, and alcohol dependence being the most common (McGough, 2017). Box 22.2 contains a screening questionnaire for ADHD in adults. BOX 22.2 Adult ADHD Screening Questions How often do you have trouble wrapping up the final details of a project once the challenging parts have been done? How often do you have difficulty getting things in order when you have to do a task that requires organization? How often do you have problems remembering appointments or obligations? https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2ITzAkY3nMIj7MBSgsqXE3qy7jjixvejaRv7GnkF88dMM%… 2/10 11/27/23, 3:51 AM Realizeit for Student When you have a task that requires a lot of thought, how often do you avoid or delay getting started? How often do you fidget or squirm with your hands or feet when you have to sit down for a long time? How often do you feel overly active and compelled to do things like you were driven by a motor? How often do you interrupt others when they are busy? How often do you finish sentences for others? How often do you have difficulty taking turns when that is required? Etiology Although much research has taken place, the definitive causes of ADHD remain unknown. There may be cortical-arousal, information-processing, or maturational abnormalities in the brain. Combined factors, such as environmental toxins, prenatal influences, heredity, and damage to brain structure and functions, are likely responsible. Prenatal exposure to alcohol, tobacco, and lead and severe malnutrition in early childhood increase the likelihood of ADHD. Although the relation between ADHD and dietary sugar and vitamins has been studied, results have been inconclusive (Spaniardi et al., 2017). Brain images of people with ADHD suggest decreased metabolism in the frontal lobes, which are essential for attention, impulse control, organization, and sustained goal-directed activity. Studies have also shown decreased blood perfusion of the frontal cortex in children with ADHD and frontal cortical atrophy in young adults with a history of childhood ADHD. Another study showed decreased glucose use in the frontal lobes of parents of children with ADHD who had ADHD themselves (Spaniardi et al., 2017). Evidence is not conclusive, but research in these areas seems promising. There seems to be a genetic link for ADHD that is most likely associated with abnormalities in catecholamine and, possibly, serotonin metabolism. Having a first-degree relative with ADHD increases the risk of the disorder by four to five times more than that of the general population (Spaniardi et al., 2017). Despite the strong evidence supporting a genetic contribution, there are also sporadic cases of ADHD with no family history of ADHD; this furthers the theory of multiple contributing factors. CLINICAL VIGNETTE: ADHD Scott is 8 years old. At 7 AM, his mother looks into Scott’s bedroom and sees Scott playing. “Scott, you know the rules—no playing before you are ready for school. Get dressed and come https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2ITzAkY3nMIj7MBSgsqXE3qy7jjixvejaRv7GnkF88dMM%… 3/10 11/27/23, 3:51 AM Realizeit for Student eat breakfast.” Although these rules for a school day have been set for the past 7 months, Scott always tests them. In about 10 minutes, he is still not in the kitchen. His mother checks his room and finds Scott on the floor, still in his pajamas, playing with miniature cars. Once he gets started doing or talking about something, it is often difficult for Scott to stop. “Scott, you need to get dressed first. Your jeans and shirt are over here on the chair.” “Mom, after school today, can we go shopping? There is the coolest new car game that anyone can play. I’d love to try it out.” As he is talking, Scott walks over to the chair and begins to pull his shirt over his head. “Scott, you’re putting your shirt over your pajamas. You need to take your pajamas off first,” his mother reminds him. Ten minutes later, Scott bounds into the kitchen, still without socks and shoes, hair tousled. “You forgot your socks, and your hair isn’t combed,” his mother reminds him. “Oh yeah. What’s for breakfast?” he says. “Scott, finish dressing first.” “Well, where are my shoes?” “By the back door where you left them.” This is the special designated place where Scott is supposed to leave his shoes so he doesn’t forget. Scott starts toward his shoes but spots his younger sister playing with blocks on the floor. He hurries to her. “Wow, Amy, watch this—I can make these blocks into a huge tower, all the way to the ceiling.” He grabs the blocks and begins to stack them higher and higher. “Scott makes a better tower than Amy,” he chants. Amy shrieks at this intrusion, but she is used to Scott grabbing things from her. The shriek brings their mother into the room. She notices Scott’s feet still do not have socks and shoes. “Scott, get your socks and shoes on now and leave Amy alone!” “Where are my socks?” he asks. “Go to your room and get a clean pair of socks and brush your teeth and hair. Then come eat your breakfast or you’ll miss the bus.” “I will in just a minute, Mom.” “No! Now! Go get your socks.” Scott continues stacking blocks. Wearily, his mother directs him toward his room. As he is looking for the socks, he is still chattering away. He finds a pair of socks and bolts in the direction of the kitchen, grabbing Amy and pinching her cheek as he swirls by her. Amy shrieks again, and he begins to chant, “Amy’s just a baby! Amy’s just a baby!” “Scott, stop it right now and come eat something! You’ve got just 10 minutes until the bus comes.” CULTURAL CONSIDERATIONS https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2ITzAkY3nMIj7MBSgsqXE3qy7jjixvejaRv7GnkF88dMM%… 4/10 11/27/23, 3:51 AM Realizeit for Student The Child Behavior Checklist, Teacher Report Form, and Youth Self Report (for ages 11–18 years) are rating scales frequently used to determine problem areas and competencies. These scales are often part of a comprehensive assessment of ADHD in children. They have been determined to be culturally competent and are widely used in various countries. The ADHD-FX has also proved to be a valid, reliable, and culturally appropriate measure of functional impairment of at-risk students (Haack & Gerdes, 2017). Parental beliefs about the causes and treatments of ADHD in their children may influence compliance with prescribed treatments. Therefore, it is important to study, determine, and include parental, cultural beliefs to enhance effectiveness for children. Treatment No one treatment has been found to be effective for ADHD; this gives rise to many different approaches such as sugar-controlled diets and megavitamin therapy. Parents need to know that any treatment heralded as the cure for ADHD is probably too good to be true. ADHD is chronic; goals of treatment involve managing symptoms, reducing hyperactivity and impulsivity, and increasing the child’s attention so that he or she can grow and develop normally. The most effective treatment combines pharmacotherapy with behavioral, psychosocial, and educational interventions. Strategies for Home and School Medications do not automatically improve the child’s academic performance or ensure that he or she makes friends. Behavioral strategies are necessary to help the child master appropriate behaviors. Environmental strategies at school and home can help the child succeed in those settings. Educating parents and helping them with parenting strategies are crucial components of effective treatment of ADHD. Effective approaches include providing consistent rewards and consequences for behavior, offering consistent praise, using time-out, and giving verbal reprimands. Additional strategies are issuing daily report cards for behavior and using point systems for positive and negative behavior. In therapeutic play, play techniques are used to understand the child’s thoughts and feelings and to promote communication. This should not be confused with play therapy, a psychoanalytic technique used by psychiatrists. Dramatic play is acting out an anxiety-producing situation, such as allowing the child to be a doctor or use a stethoscope or other equipment to take care of a patient (a doll). Play techniques to release energy could include pounding pegs, running, or working with modeling clay. Creative play techniques can help children to express themselves; for example, by drawing pictures of themselves, their family, and peers. These techniques are especially useful when children are unable or unwilling express themselves verbally. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2ITzAkY3nMIj7MBSgsqXE3qy7jjixvejaRv7GnkF88dMM%… 5/10 11/27/23, 3:51 AM Realizeit for Student Mental Health Promotion Early detection and successful intervention are often the key to mental health promotion. The SNAPIV Teacher and Parent Rating Scale is an assessment tool that can be used for initial evaluation in many areas of concern such as ADHD, ODD, conduct disorders, and depression (seeBox 22.3) . Such tools can identify problems or potential problems that signal a need for further evaluation and follow-up. BOX 22.3 The SNAP-IV Teacher and Parent Rating Scale https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2ITzAkY3nMIj7MBSgsqXE3qy7jjixvejaRv7GnkF88dMM%… 6/10 11/27/23, 3:51 AM Realizeit for Student https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2ITzAkY3nMIj7MBSgsqXE3qy7jjixvejaRv7GnkF88dMM%… 7/10 11/27/23, 3:51 AM Realizeit for Student https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2ITzAkY3nMIj7MBSgsqXE3qy7jjixvejaRv7GnkF88dMM%… 8/10 11/27/23, 3:51 AM Realizeit for Student Developed by James M. Swanson, Ph.D., University of California-Irvine. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2ITzAkY3nMIj7MBSgsqXE3qy7jjixvejaRv7GnkF88dMM%… 9/10 11/27/23, 3:51 AM Realizeit for Student Early identification and treatment of ASD are needed to help children with these disorders reach their maximum potential. Insufficient knowledge about ASD and embarrassment or reluctance to have a child diagnosed with ASD are reasons that some parents are hesitant to have children evaluated if signs of developmental delays are present. When any signs of developmental delay are detected, a thorough evaluation by a team of psychiatrist, pediatrician, physiotherapist, and neurologist can accurately identify presence of ASD, intellectual disability, language impairment, motor developmental delays, or global developmental delays. An accurate diagnosis and appropriate interventions are more likely to produce the best long-term outcomes that are available. In 1998, Dr. Andrew Wakefield, a gastroenterologist, described a type of autism reportedly caused by the MMR vaccination. This led to parental concerns about the safety of immunizations with fewer children receiving this immunization. Ten years later, Dr. Wakefield was found guilty of ethical, medical, and scientific misconduct in the publication of his paper on autism. Additional studies have proved Dr. Wakefield’s data fraudulent. However, this publication of the alleged vaccine-induced autism is one of the most damaging medical hoaxes on record. There is a high comorbidity between ADHD and other disorders, including substance use/abuse, antisocial behavior, anxiety disorders, and mood disorders (Spaniardi et al., 2017). To promote health through adulthood, individuals with ADHD could benefit from strategies to prevent other psychiatric disorders as well as early identification and treatment of coexisting disorders. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2ITzAkY3nMIj7MBSgsqXE3qy7jjixvejaRv7GnkF88dMM… 10/10