Management of ADHD by Dr. Russell Barkley

ADHD and Executive Function

Dr. Russell Barkley on ADHD

Dr. Russell Barkley - ADHD is Not A Gift

Russell A. Barkley, Ph.D., is an internationally recognized authority on attention deficit hyperactivity disorder (ADHD or ADD) in children and adults. He has specialized in ADHD for more than 35 years and is currently Clinical Professor of Psychiatry and Pediatrics at the Medical University of South Carolina. He resides in the Charleston, SC region.

Comorbid Conditions Connected With ADHD

 

What conditions can coexist with ADHD?

(From: http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/complete-index.shtml)

Some children with ADHD also have other illnesses or conditions. For example, they may have one or more of the following:

• A learning disability. A child in preschool with a learning disability may have difficulty understanding certain sounds or words or have problems expressing himself or herself in words. A school-aged child may struggle with reading, spelling, writing, and math.
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• Oppositional defiant disorder. Kids with this condition, in which a child is overly stubborn or rebellious, often argue with adults and refuse to obey rules.
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• Conduct disorder. This condition includes behaviors in which the child may lie, steal, fight, or bully others. He or she may destroy property, break into homes, or carry or use weapons. These children or teens are also at a higher risk of using illegal substances. Kids with conduct disorder are at risk of getting into trouble at school or with the police.
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• Anxiety and depression. Treating ADHD may help to decrease anxiety or some forms of depression.
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• Bipolar disorder. Some children with ADHD may also have this condition in which extreme mood swings go from mania (an extremely high elevated mood) to depression in short periods of time.
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• Tourette syndrome. Very few children have this brain disorder, but among those who do, many also have ADHD. Some people with Tourette syndrome have nervous tics and repetitive mannerisms, such as eye blinks, facial twitches, or grimacing. Others clear their throats, snort, or sniff frequently, or bark out words inappropriately. These behaviors can be controlled with medication.

ADHD also may coexist with a sleep disorder, bed-wetting, substance abuse, or other disorders or illnesses.
For more information on these disorders, visit the NIMH website.

An ADHD Diagnosis Requires a Comprehensive Evaluation

According to Barbara D.Ingersoll, Ph. D. in her book Daredevils and Daydreamers: New Perspectives on Attention-Deficit/Hyperactivity Disorder, a diagnosis of ADHD requires a comprehensive evaluation by a licenced medical professional (pediatrictian or psychiatrist, for example) with specialized training in this area. No laboratory medical test can confirm the presence of ADHD. A medical professional will use a range of ways to gather information to confirm a diagnosis:

• parent interview, which includes gathering information about the child's health and medical history, motor and language development, psychological history, and educational experiences. Questions will also be asked about family life and members.
• a developmental history questionnaire filled out by parent
• child interview/observation - most children are aware of their difficulties
• family relationships will be explored
• review of reports from other professionals - mental health professionals, family doctor, educators, speech and language pathologist, occupational therapist, etc.
• all report cards - the comments by teachers given on report cards are an important source of information. It is important that teachers give accurate and specific details about academic and behavioural issues on report cards.
• samples of child's schoolwork
• results of standardized testing (psycho-educational reports) if done
• Rating Scales, such as Conners' Parent Rating Scale (revised), Child Behaviour Checklist, Home Situations Questionnaire, Attention Deficit Disorders Evaluation Scale, Conners' Teacher Rating Scale (revised), ADD-H Comprehensive Teacher's Rating Scale (ACTeRS), School Situations Questionnaire.
• Other tests may include Continuous Performance Tests such as Conners' Continuous Performance Test and the Test of Variables of Attention (TOVA) and Tests of Intelligence and Achievement. 

Also, according to The National Institute of Mental Health, the medical professional will rule out:

• undetected seizures

• a middle ear infection that is causing hearing problems
• any undetected hearing or vision problems
• any medical problems that affect thinking and behavior
• learning disabilities
• anxiety or depression, or other psychiatric problems that might cause ADHD-like symptoms
• if the child has been affected by a significant and sudden change, such as the death of a family member, a divorce, or parent’s job loss.

DSM IV TR Diagnostic Criteria ADHD (APA)

DSM IV TR Diagnostic Criteria ADHD (APA)

A.Either 1 or 2:

1. Inattention:

six (or more) of the following symptoms

of inattention have persisted for at least 6 months to a

degree that is maladaptive and inconsistent with

developmental level:

1. often fails to give close attention to details or makes

careless mistakes in schoolwork, work, or other

activities

2. often has difficulty sustaining attention in tasks or

play activities

3. often does not seem to listen when spoken to

directly

4. often does not follow through on instructions and

fails to finish school work, chores, or duties in the

workplace (not due to oppositional behaviour or

failure to understand instructions)

5. often has difficulty organizing tasks and activities

6. often avoids, dislikes, or is reluctant to engage in

tasks that require sustained mental effort (such as

school work or homework)

7. often loses things necessary for tasks and activities

(toys, school assignments, pencils, books, or tools)

8. is often easily distracted by extraneous stimuli

9. is often forgetful in daily activities

2. Hyperactivity-Impulsivity: six (or more) of the

following symptoms of hyperactivity-impulsivity have

persisted for at least 6 months to a degree that is

maladaptive and inconsistent with developmental level:

Hyperactivity

1. often fidgets with hands or feet or squirms in seat

2. often leaves seat in classroom or in other situations in

which remaining seated is expected

3. often runs or climbs excessively in situations in which

it is inappropriate (in adolescents or adults, may be

limited to subjective feeling of restlessness)

4. often difficulty playing or engaging in leisure activities

quietly

5. often “on the go” or often acts as if “driven by motor”

6. often talks excessively

Impulsivity

7. often blurts out answers before questions have been

completed

8. often has difficulty awaiting turn

9. often interrupts or intrudes on others (eg., butts into

conversations or games)

 

B. Some hyperactive-impulsive or inattentive

symptoms that caused impairment were present

before 7 years of age

C. Some impairment from the symptoms is present in

two or more settings (eg., at school [or work] and

at home)

D. There must be clear evidence of clinically

significant impairment in social, academic, or

occupational functioning

E. The symptoms do not occur exclusively during the

course of a Pervasive Developmental Disorder,

Schizophrenia, or other Psychotic Disorder and are

not better accounted for by another mental

disorder (eg., Mood Disorder, Anxiety Disorder,

Dissociative Disorders, or a Personality Disorder)

Code based on type:

ADHD Combined Type

ADHD Predominantly Inattentive Type

ADHD Predominantly Hyperactive-Impulsive Type

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