Assessment Of ADHD Research Articles

39: Contemporary Challenges Faced by Canadian Physicians in ADHD Management

The management of ADHD remains filled with areas of uncertainties for specialists involved in patient care. To identify the challenges in ADHD management in Canada. Between December 2013 and June 2014, 40 specialists and 10 primary care physicians (PCPs) from across Canada participated in the online REFLECT survey (pilot project) that assessed their perceptions regarding their ADHD practice. Actual practice was evaluated via 414 chart audits – three visits/patient over five months. The cumulative loss to follow up (n=414) was 38 by Visit 1 and 119 by Visit 2. Paediatricians, child/adolescent psychiatrists and PCPs comprised 48%, 22% and 20% of the respondents, respectively; 76% and 48% had been in practice and treating ADHD for >20 years, respectively. The survey revealed that most respondents perceived themselves to closely follow best practices and guidelines; however, while 78% reported using rating scales to monitor response and all prioritized duration of efficacy as predominantly dictating the choice of pharmacotherapy, the review of the chart audits suggest otherwise. Figure 1 summarises the perceived vs actual use of rating scales in establishment of patient-defined treatment goals at each visit stratified by speciality. Pharmacotherapy was changed for 40% and 37% of patients at Visits 1 and 2, respectively. Suboptimal symptom control resulted in intensification (up-titration; Visit 1 73%; Visit 2 68% or addition of another agent; Visit 1 44%; Visit 2 30%) or discontinuations without replacement (Visit 1 43%, Visit 2 32%). Side effects triggered down-titration for 55% and 45% of patients at both Visits 1 and 2, respectively. The pilot phase of the REFLECT survey and chart audit suggest wide inconsistencies in the assessment and management of ADHD in Canadian specialist and primary care practices that are likely contributing to the persistent care gap. The national IRB approved REFLECT survey study should confirm these findings.

PP11.6 – 2858: ADHD predominantly inattentive subtype, interictal epileptiform discharges and use of methylphenidate for ADHD

Objective Interictal epileptiform discharges (IED) occur more often in children with attention deficit/hyperactivity disorder predominantly inattentive subtype (ADHD-I), and may contribute to the occurrence of ADHD symptoms in some cases. The aim of the present study was to investigate whether IED in children with ADHD-I influence the use of methylphenidate (MPH) during one year follow-up. Methods 517 children diagnosed with ADHD (82% male), age 5–14 years, performed routine awake EEG at ADHD assessment over 6 years period. 39 had EEG with IED. The group with IED was compared to an age and gender matched control group without IED. The groups showed no differences in using of MPH during one year follow-up. This study examined whether IED influence the use of MPH in a subgroup with ADHD-I with and without IED. Outcome measures were: initial positive response to MPH after 4–6 weeks titration, and the use of MPH at one-year follow-up. Results ADHD-I was diagnosed in 22 of 78 cases. 16 of 22 had IED, and 4 had previous history of epilepsy. Of the 16 cases with IED, 14 (87.5%) hade initial positive response to MPH, and 13 (81.3%) used MPH at one year follow-up. ADHD-I without IED was found in 6. Of the 6 cases with ADHD-I without IED, 5 (83.3%) had positive initial response to MPH, and 5 (83.3%) used MPH at one year follow-up. There was no statistic difference between the groups in using of MPH. Conclusion There is a higher occurrence of IED in ADHD-I. This study suggested that IED occurrence in ADHD-I does not influence the use of MPH during one year follow-up.

On-line Puzzle Game Based Assessment & Training for Adhd

Attention-deficit hyperactivity disorder (ADHD) is the most prevalent and impairing neurodevelopmental disorder, with worldwide estimates of 5.29%. ADHD is clinically characterized by hyperactivity-impulsivity and inattention, with neuropsychological deficits in executive functions, attention, working memory and inhibition. These cognitive processes rely on prefrontal cortex function; cognitive training programs enhance performance of ADHD participants supporting the idea of neuronal plasticity. Here we propose the development of an on-line puzzle game based assessment and training tool in which participants must deduce the ‘winning symbol’ out of N distracters. To increase ecological validity of assessments strategically triggered Twitter/Facebook notifications will challenge the ability to ignore distracters. In the UK, significant cost for the disorder on health, social and education services, stand at £23m a year. Thus the potential impact of neuropsychological assessment and training to improve our understanding of the pathophysiology of ADHD, and hence our treatment interventions and patient outcomes, cannot be overstated.

ADHD and Comorbid Disorders in Childhood Psychiatric Problems, Medical Problems, Learning Disorders and Developmental Coordination Disorder

ADHD is a common disorder for children and is highly comorbid with a number of psychiatric and somatic disorders, which leads to important social impacts. Among common comorbid psychiatric disorders, mood, anxiety and conduct disorders are among the most frequently encountered in clinical practice. Furthermore, there is also some overlap between ADHD and addictive behavior, OCD, tics sleeping disorder and specific learning disorder. Likewise, autistic spectrum disorder and eating disorder are more and more recognized as comorbid entities. Lastly, links with PTSD and attachment disorder have been noted. Other medical issues should also be considered in the assessment of ADHD: brain injury, epilepsy and obesity for example. ADHD children with a co-occurring condition are severely impaired and treatment is more complex. A better comprehension of the high rates of comorbidities with ADHD is necessary to optimize treatment of this condition and prevent some of the negative outcomes associated with comorbid ADHD.

Attention-deficit hyperactivity disorder in children and adolescents: assessment and treatment

SummaryAttention-deficit hyperactivity disorder (ADHD) is a heterogeneous neurobehavioural syndrome, complex in aetiology and presentation. It is characterised by symptoms of inattention, hyperactivity and impulsivity of varying combinations and degrees of severity. This article seeks to elucidate the different components of the assessment and diagnosis of ADHD in comparison with various differential diagnoses that must also be considered. Despite its complexities, ADHD can be effectively managed using a comprehensive approach advocated by the National Institute for Health and Care Excellence (NICE). The article discusses the combination of medication, psychoeducation and parental handling that has been shown to be effective in containing the problematic symptoms of ADHD. It also highlights the difficulties that can persist into adulthood and potential strategies to improve prognosis.

Ratings of ADHD symptoms and academic impairment by mothers, fathers, teachers, and aides: construct validity within and across settings as well as occasions.

A Multiple Indicator × Multiple Trait × Multiple Source × Multiple Occasion design was used to evaluate invariance, convergent and discriminant validity of ADHD-inattention (IN), ADHD-hyperactivity/impulsivity (HI), and academic impairment scores from the Child and Adolescent Disruptive Behavior Inventory (CADBI) using confirmatory factor analysis. Mothers, fathers, teachers, and aides completed the CADBI on 811 Spanish 1st-grade children (54% boys) twice (6-week separation). For mothers and fathers, like loadings, thresholds/intercepts, factor means, factor variances, and factor covariances/correlations were invariant across sources and occasions. All 3 factors also showed convergent (convergent correlations from .69 to .83) and significant discriminant validity. For teachers and aides, there was also invariance of parameters along with convergent and discriminant validity over sources and occasions (convergent correlations from .67 to .87). With construct validity established for home and school, it was meaningful to test construct validity between home and school. Like-item loadings and thresholds/intercepts were invariant between home and school, with the ADHD-HI factor mean being lower at school. Convergent validity of ADHD-IN, ADHD-HI, and academic impairment factors, especially ADHD-IN and ADHD-HI, was much weaker between home and school (convergent correlations from .36 to .47 for IN and HI). The strong convergent validity of ADHD-IN and ADHD-HI scores within home and school in conjunction with weak convergent validity across home and school has implications for the assessment and diagnosis of ADHD (i.e., the diagnostic criteria of symptom occurrence in 2 or more settings).

ADHD assessment tool unlocks the truth.

Elaine Cole reports on a computerised tool that is transforming the care of children with attention deficit hyperactivity disorder

Association of symptoms of attention-deficit/hyperactivity disorder with symptoms of excessive exercising in an adult general population sample.

BackgroundAn increasing number of studies suggest that physical activity can alleviate symptoms of ADHD in children. In adults there are currently insufficient data available on this subject. Interestingly, ADHD and forms of excessive exercising have both been shown to occur more frequently in adult athletes. The aim of the present study was to empirically investigate the association of ADHD and excessive exercising in the adult general population.MethodsFor diagnosis of adult and childhood ADHD a large representative sample of the German general population (n = 1,615) completed a retrospective assessment of childhood ADHD and a self-report assessment of adult ADHD. Excessive exercising as well as putative mediating variables such as eating related psychopathology, depression, and anxiety were assessed using standardized self-rating instruments.ResultsIndividuals with childhood only ADHD had a significantly higher frequency of excessive exercising (9.0%) than individuals without ADHD (2.7%). Excessive exercising was significantly associated with childhood only ADHD compared to no ADHD with an odds ratio of 3.239 even after controlling for socio-demographic variables, BMI, eating related and general psychopathology.ConclusionsOur data show that excessive exercising is significantly overrepresented in individuals in which ADHD symptoms in childhood have not persisted into adulthood. We thus hypothesize that a subgroup of individuals might suppress ADHD symptoms by excessive sporting activities. Although in healthy adults physical activity has been associated with immediate and long term improvements in cognitive functioning, studies empirically investigating associations between the effects of physical activity and adult ADHD are rare. Further studies are warranted to explore the potential role of physical activity in the treatment of ADHD in adults.

Academic Buoyancy, Resilience, and Adaptability in Students with ADHD

Academic Buoyancy, Resilience, and Adaptability in Students with ADHDAndrew J. Martin and Emma C. BurnsAndrew J. MartinProfessor Andrew J. Martin can be contacted at School of Education, University of New South Wales, Sydney NSW 2052, Australia. E-mail: [email protected]Search for more papers by this author and Emma C. BurnsSchool of Education at the University of New South Wales.Search for more papers by this authorPublished Online:September 2014https://doi.org/10.1521/adhd.2014.22.6.1PDFPDF PLUS ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations About Next article FiguresReferencesRelatedDetails Cited byCited by1. Symptoms of ADHD Predict Lower Adaptation to the COVID-19 Outbreak: Financial Decline, Low Adherence to Preventive Measures, Psychological Distress, and Illness-Related Negative PerceptionsOnline publication date: 29 June 2021. Go to citation Crossref Google Scholar2. Investigating the reciprocal relations between academic buoyancy and academic adversity: Evidence for the protective role of academic buoyancy in reducing academic adversity over timeOnline publication date: 4 November 2019. Go to citation Crossref Google Scholar3. Effect of debate on development of adaptability in EFL university classroomsOnline publication date: 25 February 2019. Go to citation Crossref Google Scholar4. Adaptability: does students’ adjustment to university predict their mid-course academic achievement and satisfaction?Online publication date: 1 October 2018. Go to citation Crossref Google Scholar5. The Assessment of ADHD in Persons with Developmental DisabilitiesOnline publication date: 14 September 2018. Go to citation Crossref Google Scholar6. ADHD, personal and interpersonal agency, and achievement: Exploring links from a social cognitive theory perspectiveOnline publication date: Go to citation Crossref Google Scholar7. Adaptability, engagement and academic achievement at universityOnline publication date: 14 September 2016. Go to citation Crossref Google Scholar8. Social and Emotional Learning, Social and Emotional Competence, and Students’ Academic Outcomes: The Roles of Psychological Need Satisfaction, Adaptability, and BuoyancyOnline publication date: 8 March 2017. Go to citation Crossref Google Scholar9. Social and Emotional Competence and At-Risk Children’s Well-Being: The Roles of Personal and Interpersonal Agency for Children with ADHD, Emotional and Behavioral Disorder, Learning Disability, and Developmental DisabilityOnline publication date: 8 March 2017. Go to citation Crossref Google Scholar Volume 22Issue 6Sep 2014 Information© 2014 The Guilford PressPDF download

Neuropsychologically informed strategic psychotherapy in teenagers and adults with ADHD.

Stimulants are the primary treatment for ADHD. Psychotherapy may augment pharmacologic treatment. In this article, we discuss strategies psychotherapists may use in working with teenagers and adults, including individuals who reject medications or take them suboptimally. Individuals with ADHD often have other psychiatric issues, including affective or cognitive comorbidities. Having ADHD does not protect people from the difficulties of life, and psychotherapy can help to disentangle "ADHD" from other issues. A psychotherapist knowledgeable about ADHD assessment can improve diagnostic precision. Psychotherapy can integrate forms of treatment in which the central goal is increasing mastery and competence of the individual.

Altered event-related potentials in adults with ADHD during emotional faces processing

ObjectiveThis study investigated behavioral and neural correlates of emotional processing in adults with ADHD using scalp-recorded event-related potentials (ERPs). MethodsWe used a visual-emotional oddball paradigm, in which subjects were confronted with neutral and emotional faces (happy and angry). Responses to target and non-target stimuli were compared across groups of 17 adults with ADHD and 20 control subjects. ResultsParticipants with ADHD had slower RTs than controls in response to happy but not to angry faces. ADHD participants, but not controls, responded faster to angry than to happy faces. ERP results indicated that group significantly interacted with the type of facial expression. P1 was significantly increased for the ADHD group compared with controls, but only to emotional (and not to neutral) faces. In the ADHD group, but not in controls, P1 was greater in response to emotional compared with neutral faces. N170 was more pronounced to angry than to happy faces in the ADHD group, while in the control group N170 was more pronounced to happy than to angry faces. Participants with ADHD showed a pronounced reduction in P3 to both emotional and neutral faces. ConclusionsThe current results provide indication of altered behavioral responses as well as altered P1, N170 and P3 to emotional faces in adults with ADHD compared with healthy controls. SignificanceBehavioral and brain function measures of emotion processing may provide valuable additional tools for clinical assessment of ADHD in adulthood.

Cuestionarios TDAH para profesores. Un análisis desde los criterios del DSM-IV-TR y DSM-V = Adhd questionnaire for teachers. An analysis from the DSM-IV-TR and DSM-V criteria

ABSTRACTFrequently in scholar context orientation professionals should make an evaluation from the students who present ADHD, using different demonstrated efficacy assessment tools. Taking as reference point the current criteria for the diagnosis of this disorder a qualitative analysis of the items is performed in six scales and questionnaires to collect information from teachers to the ADHD assessment. An assignation from every item to DSM-V criteria allows an analysis from the most frequent items, which ones have been omitted and which ones cannot be classified in any diagnostic criteria because of being referred to different kind of problems. It is noted some items whose are frequently observed and relevant in the school environment do not usually take part of the analyzed instruments or they are underrepresented in them. A good practice strategy is proposed to councilors to conduct proper counseling at school, selecting those tools to assess as many symptoms as possible. Professionals in educational guidance should go further the data offered by a few standardized instruments to offer the proper educational answer to such a complex reality as the ADHD is.

Assessment of ADHD based on parameters related to visual detection of changes

The diagnosis of attention disorders (ADHD) is controversial and the question of what constitutes an attention deficit still needs to be unequivocally answered. Hence, it is important to define objective indicators that could help in reaching a diagnosis. Several studies have found a high relationship between some tasks related to perception and attention with/without hyperactivity disorders. In order to verify a relation between ADHD and binocular vision we tested 24 children (12 with ADHD and 12 Controls) in an experiment using the paradigms of binocular rivalry and change detection. We recorded the alternations rate, the time at the onset of rivalry, and the exclusive predominance periods for each percept. Analysis of theses parameters (ANOVA) derived from binocular rivalry task revealed differences between ADHD and Control groups. In conclusion, our data provide support to the link between ADHD and binocular rivalry, i.e., visual attention and binocular vision are narrowly linked.

Does IQ influence associations between ADHD symptoms and other cognitive functions in young preschoolers?

BackgroundWorking memory, inhibition, and expressive language are often impaired in ADHD and many children with ADHD have lower IQ-scores than typically developing children. The aim of this study was to test whether IQ-score influences associations between ADHD symptoms and verbal and nonverbal working memory, inhibition, and expressive language, respectively, in a nonclinical sample of preschool children.MethodsIn all, 1181 children recruited from the Norwegian Mother and Child Cohort Study were clinically assessed at the age of 36 to 46 months. IQ-score and working memory were assessed with subtasks from the Stanford Binet test battery, expressive language was reported by preschool teachers (Child Development Inventory), response inhibition was assessed with a subtask from the NEPSY test, and ADHD symptoms were assessed by parent interview (Preschool Age Psychiatric Assessment).ResultsThe results showed an interaction between ADHD symptoms and IQ-score on teacher-reported expressive language. In children with below median IQ-score, a larger number of ADHD symptoms were more likely to be accompanied by reports of lower expressive language skills, while the level of ADHD symptoms exerted a smaller effect on reported language skills in children with above median IQ-score. The associations between ADHD symptoms and working memory and response inhibition, respectively, were not influenced by IQ-score.ConclusionsLevel of IQ-score affected the relation between ADHD symptoms and teacher-reported expressive language, whereas associations between ADHD symptoms and working memory and response inhibition, respectively, were significant and of similar sizes regardless of IQ-score. Thus, in preschoolers, working memory and response inhibition should be considered during an ADHD assessment regardless of IQ-score, while language skills of young children are especially important to consider when IQ-scores are average or low.

School-Based Assessment of ADHD: Purpose, Alignment With Best Practice Guidelines, and Training

Youth exhibiting symptoms of attention deficit hyperactivity disorder are frequently referred to school psychologists because of academic, social, and behavioral difficulties that they face. To address these difficulties, evidence-based assessment methods have been outlined for multiple purposes of assessment. The goals of this study were to delineate school psychologists’ (a) primary purpose of their assessment of attention deficit hyperactivity disorder (i.e., screening, diagnosis, placement, intervention planning, progress monitoring), (b) use of recommended assessment tools/strategies and the perceived importance of each recommended tool/strategy for decision making, and (c) their perceived adequacy of training regarding attention deficit hyperactivity disorder assessment. Surveys from 217 school psychologists identified intervention planning as the primary purpose of assessment. Participants reported following recommended guidelines most frequently for diagnosis, impairment, and intervention development; they were least likely to follow guidelines for progress monitoring, evaluating outcomes, and assessing integrity. Participants reported being best trained for screening and placement, and least well trained in evaluating outcomes and developing interventions. Implications for practice and future research are discussed.

O83 – 2038 Do rolandic spikes on EEG at ADHD assessment influence on ADHD subtype and the use of methylphenidate for ADHD?

O83 – 2038 Do rolandic spikes on EEG at ADHD assessment influence on ADHD subtype and the use of methylphenidate for ADHD?

Association between family environment and attention deficit hyperactivity disorder in children – mothers’ and teachers’ views

BackgroundTo ascertain whether factors of the family environment and gestational period are associated with the appearance of ADHD in children, as reported by various different informants (mothers and teachers).MethodsThis paper presents results from the dataset of a longitudinal study to evaluate behavioral problems among schoolchildren in São Gonçalo, Rio de Janeiro State, in 2005 and 2006. The cross-section considered for this paper comprises records of exposure factors and ADHD. In all, 370 schoolchildren of the public school system were assessed by 3-stage cluster sampling. The Child Behavior Checklist (CBCL) and the Teacher Report Form (TRF) were used to measure outcomes. The exposure factors examined were: profile of child and mother, variables relating to the family environment, and perinatal considerations. The questions were answered by mothers and teachers. A hierarchical logistic regression model was used.ResultsPrecariously functioning families, lack of social support for mothers, adverse life events and discord during pregnancy were the factors associated with mother-reported ADHD. When ADHD was reported by teachers, the variables selected were: Intelligence quotient (IQ) and sex, with children with low IQ scores and boys more likely to display the disorder.ConclusionsAssessment of ADHD by teachers or mothers reveals specific characteristics that reflect how each of these informants understands the children. This highlights the importance of using informants from different environments in diagnosing the disorder.

Screening for substance use disorders in neurodevelopmental disorders: a clinical routine?

Evidence suggests that substance use disorders (SUD) tend to be underdiagnosed in psychiatry. The objective of this study was to investigate whether drug and alcohol screening is a clinical routine in the assessment of two prominent neurodevelopmental disorders, namely ADHD and autism spectrum disorder (ASD). We surveyed drug and alcohol screening routines in 34 general child and adolescent (only practice for adolescents, not children, was assessed) and 29 adult psychiatric outpatient departments in Stockholm County, Sweden. Structured telephone interviews mapping SUD screening procedures were conducted with department representatives in charge. Only a minority of child and adolescent departments regularly used SUD screening questionnaires (6%) in ADHD and ASD assessment, while this was more common in adult psychiatry (55%). Urine/blood-based toxicology tests were always used in 28% and sometimes or in case of clinical suspicion in 38% of the adult units. Such tests were used sometimes or in case of clinical suspicion in 15% of the child psychiatric departments, but never routinely. Findings reveal that screening for SUD in ADHD and ASD is not an integral part of routine clinical assessments in psychiatry, although increasingly an integral part of many clinical guidelines. Thus, SUD might be underdiagnosed in neurodevelopmental disorders, which could be particularly true for child and adolescent psychiatry settings.

Determining the Accuracy of Self-Report Versus Informant-Report Using the Conners’ Adult ADHD Rating Scale

Objective: The present research examined the validity of self-report versus informant-report in relation to a performance-based indicator of adult ADHD. Method: Archival data from 118 participants (52 males, 66 females) were used to compare Conners’ Adult ADHD Rating Scale–Self-Report: Long Format (CAARS-S:L) and Conners’ Adult ADHD Rating Scale–Observer Report: Long Format (CAARS-O:L) with discrepancy scores calculated between the Wechsler Adult Intelligence Scale–Third Edition (WAIS-III) Verbal Comprehension Index – Working Memory Index (VCI – WMI) and Perceptual-Organizational Index – Processing Speed Index (POI – PSI) scaled scores. Results: Neither the self- nor informant-report formats of the CAARS were better predictors of discrepancies between WAIS-III Index scores. Intercorrelations between the CAARS-S:L and CAARS-O:L revealed generally higher correlations between the same scales of different formats and among scales measuring externally visible symptoms. Furthermore, regression analysis indicated that both the CAARS-S:L and CAARS-O:L clinical scales contributed a significant proportion of variance in WAIS-III VCI – WMI discrepancy scores (14.7% and 16.4%, respectively). Conclusion: Results did not establish greater accuracy of self-report versus informant-report of ADHD symptomatology, rather demonstrate the need for multimodal assessment of ADHD in adults.

The Assessment and Diagnosis of Attention Deficit Hyperactivity Disorder in Adult Forensic Psychiatric Outpatients

The primary purpose of the present study was to examine the validity of commonly utilized ADHD rating scales within an adult forensic population. Participants were 120 patients assessed for dysfunctional anger and impulsive aggression at a hospital-based clinic. Two psychiatrists made independent diagnoses about the presence or absence of ADHD among individuals presenting with symptoms consistent with this disorder. Following the diagnoses, participants were assessed with multiple ADHD measures, including measures based on self-report, observer-report, or a computerized neuropsychological measure (IVA + Plus). With the exception of the IVA + Plus, the ADHD measures significantly differentiated individuals diagnosed with ADHD from individuals who were not so diagnosed. These measures also demonstrated good diagnostic utility via test specific parameters (sensitivity, specificity, positive predictive power, and negative predictive power). A sub-set of measures demonstrated particularly good classification accuracy, with high sensitivity (91 %) and good specificity (81 %). Implications of these findings for the effective assessment and diagnosis of ADHD in adult outpatient psychiatric settings are discussed.