ADD & ADHD: Current Issues in Pediatric Health

Kristen Hedger Archbold, RN, PhDAssistant ProfessorUniversity of Arizona College of NursingFaculty, 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 – 4th 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.