Management Of Attention Deficit Hyperactivity Disorder Research Articles

Caregiver Treatment Preferences for Children with a New Versus Existing Attention-Deficit/Hyperactivity Disorder Diagnosis.

Parental experiences with managing their child's attention-deficit/hyperactivity disorder (ADHD) can influence priorities for treatment. This study aimed to identify the ADHD management options caregivers most prefer and to determine if preferences differ by time since initial ADHD diagnosis. Primary caregivers (n = 184) of a child aged 4-14 years old in care for ADHD were recruited from January 2013 through March 2015 from community-based pediatric and mental health clinics and family support organizations across the state of Maryland. Participants completed a survey that included child/family demographics, child clinical treatment, and a Best-Worst Scaling (BWS) experiment to elicit ADHD management preferences. The BWS comprised 18 ADHD management profiles showing seven treatment attributes, where the best and worst attribute levels were selected from each profile. A conditional logit model using effect-coded variables was used to estimate preference weights stratified by time since ADHD diagnosis. Participants were primarily the mother (84%) and had a college or postgraduate education (76%) with 75% of the children on stimulant medications. One-on-one caregiver behavior training, medication use seven days a week, therapy in a clinic, and an individualized education program were most preferred for managing ADHD. Aside from caregiver training and monthly out-of-pocket costs, caregivers of children diagnosed with ADHD for less than two years prioritized medication use lower than other care management attributes and caregivers of children diagnosed with ADHD for two or more years preferred school accommodations, medication, and provider specialty. Preferences for ADHD treatment differ based on the duration of the child's ADHD. Acknowledging that preferences change over the course of care could facilitate patient/family-centered care planning across a range of resources and a multidisciplinary team of professionals.

Attention deficit hyperactivity disorder: Psychopharmacology and nurse prescribing

This article explores the assessment, treatment and management of ADHD by nurses. Although the main focus is on pharmacological treatments, these are only one part of support and management strategies. Self-care, psychological interventions, family-based support are all important for nurses to consider when providing holistic care and treatment for children and young people with ADHD.

Optimizing outcomes in ADHD treatment: from clinical targets to novel delivery systems

Our knowledge and understanding of the underlying neurobiology and symptomatic expression of ADHD has advanced dramatically over the past decade. Associated with these advances has been a similar explosion of new treatment options to individualize treatment for our patients. This article will: ∙ review strategies to measure ADHD symptoms and functional difficulties while seeking to achieve full symptomatic remission throughout the day ∙ summarize recent findings regarding the management and prioritization of ADHD and comorbid conditions and ∙ discuss the various pharmacologic treatment options with a focus on recently developed molecules and novel delivery systems.

Treatment Controversies in Adult ADHD.

Treatment Controversies in Adult ADHD.

Practical guide to the management of ADHD

Practical guide to the management of ADHD

Attention-deficit hyperactivity disorder in adults

Attention-deficit hyperactivity disorder (ADHD) is one of the most-common psychiatric disorders; it is highly comorbid with many other psychiatric disorders and associated with substantial role impairment. Untreated ADHD results in psychiatric comorbidity, relationship and parenting problems, underachievement, frequent job losses, and opportunistic delinquency. Nevertheless, ADHD remains the most under-recognised and undertreated mental health condition in adults. This article discusses the clinical presentation of ADHD in adulthood with a particular focus on recognition, assessment and management of ADHD in adults in primary care.

Variabilidad y tendencias en el consumo de fármacos para los trastornos por déficit de atención e hiperactividad en Castilla-La Mancha, España (1992-2015)

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common behavioural disorders of childhood; its prevalence in Spain is estimated at 5-9%. Available treatments for this condition include methylphenidate, atomoxetine, and lisdexamfetamine, whose consumption increases each year. The prevalence of ADHD was estimated by calculating the defined daily dose per 1,000 population per day of each drug and the total doses (therapeutic group N06BA) between 1992 and 2015 in each of the provinces of Castile-La Mancha (Spain). Trends, joinpoints, and annual percentages of change were analysed using joinpoint regression models. The minimum prevalence of ADHD in the population of Castile-La Mancha aged 5 to 19 was estimated at 13.22 cases per 1,000 population per day; prevalence varied across provinces (p<.05). Overall consumption has increased from 1992 to 2015, with an annual percentages of change of 10.3% and several joinpoints (2000, 2009, and 2012). methylphenidate represents 89.6% of total drug consumption, followed by lisdexamfetamine at 8%. Analysing drug consumption enables us to estimate the distribution of ADHD patients in Castile-La Mancha. Our data show an increase in the consumption of these drugs as well as differences in drug consumption between provinces, which reflect differences in ADHD management in clinical practice.

MODEL KONSELING KELOMPOK UNTUK ANAK DENGAN GANGGUAN PEMUSATAN PERHATIAN DISERTAI HIPERAKTIVITAS (GPPH)

Abstract, The core Symptoms of Attention Deficit/hyperactivity disorder (ADHD) are hyperactivity, impulsivity, and inattention, that have impact to behavior problems, academic working social, emotional and self system. Most of the diagnosis of ADHD will retain into adulthood, and has had a longlife impact to adults with ADHD. The number of children wwith ADHD in the world and particularly in Indonesia continues to increase. Current best practice guidleines advocate a multidisciplinary approach to the management of ADHD. One of the psychoeducational approach is group counseling for school based intervention that can be provided y school coounselor. Issues of self-esteem and academic/social relationships are often successfully dealt with in counseling. There are three group counseling models that can be proposed as counseling intervention in the school setting, that are Rational Emotive Behavior Therapy, Cognitive Behavior Therapy, and adventure Based Counseling/Adlerian Play TherapyKeyword: Counseling group; children; GPPH

Teachers’ intended classroom management strategies for students with ADHD: a cross-cultural study between South Korea and Germany

&lt;b&gt;Background&lt;/b&gt;&lt;br /&gt; The purpose of this study was to investigate Korean and German teachers’ intentions of using classroom management strategies (CMS) for students with attention-deficit/hyperactivity disorder (ADHD) based on the theory of reasoned action (TRA) and the theory of planned behavior (TPB).&lt;br /&gt; &lt;br /&gt; &lt;b&gt;Participants and procedure&lt;/b&gt;&lt;br /&gt; Participants were 639 Korean and 317 German teachers. Disproportional stratified sampling was used. As a result, 264 Korean and 264 German matched teachers were obtained. Kos’s questionnaire was slightly modified. The survey instrument was distributed from September 2012 to December 2013. SPSS 22.0 was used to analyze the data. &lt;br /&gt; &lt;br /&gt; &lt;b&gt;Results&lt;/b&gt;&lt;br /&gt; Korean teachers were more influenced by norms of colleagues and parents than German teachers were. Teachers in both countries have more favorable attitudes towards positive-oriented CMS compared to negative-oriented CMS, and perceived themselves as being able to control all CMS in the classroom. The TRA proved to better predict both Korean and German teachers’ intentions of using CMS compared to the TPB.&lt;br /&gt; &lt;br /&gt; &lt;b&gt;Conclusions&lt;/b&gt;&lt;br /&gt; This study is an important step towards understanding teachers’ CMS in the cultural context of Korea and Germany. The findings of this study will be an essential resource to develop an ADHD management manual based on theoretical and cultural perspectives, so that teachers in both countries are prepared for students with ADHD in their classroom, rather than give up on them.

Vital Signs: National and State-Specific Patterns of Attention Deficit/Hyperactivity Disorder Treatment Among Insured Children Aged 2-5 Years - United States, 2008-2014.

Attention deficit/hyperactivity disorder (ADHD) is associated with adverse outcomes and elevated societal costs. The American Academy of Pediatrics (AAP) 2011 guidelines recommend "behavior therapy" over medication as first-line treatment for children aged 4-5 years with ADHD; these recommendations are consistent with current guidelines from the American Academy of Child and Adolescent Psychiatry for younger children. CDC analyzed claims data to assess national and state-level ADHD treatment patterns among young children. CDC compared Medicaid and employer-sponsored insurance (ESI) claims for "psychological services" (the procedure code category that includes behavior therapy) and ADHD medication among children aged 2-5 years receiving clinical care for ADHD, using the MarketScan commercial database (2008-2014) and Medicaid (2008-2011) data. Among children with ESI, ADHD indicators were compared during periods preceding and following the 2011 AAP guidelines. In both Medicaid and ESI populations, the percentage of children aged 2-5 years receiving clinical care for ADHD increased over time; however, during 2008-2011, the percentage of Medicaid beneficiaries receiving clinical care was double that of ESI beneficiaries. Although state percentages varied, overall nationally no more than 55% of children with ADHD received psychological services annually, regardless of insurance type, whereas approximately three fourths received medication. Among children with ESI, the percentage receiving psychological services following release of the guidelines decreased significantly by 5%, from 44% in 2011 to 42% in 2014; the change in medication treatment rates (77% in 2011 compared with 76% in 2014) was not significant. Among insured children aged 2-5 years receiving clinical care for ADHD, medication treatment was more common than receipt of recommended first-line treatment with psychological services. Among children with ADHD who had ESI, receipt of psychological services did not increase after release of the 2011 guidelines. Scaling up evidence-based behavior therapy might lead to increased delivery of effective ADHD management without the side effects of ADHD medications.

Treatment of Attention-Deficit/Hyperactivity Disorder in Preschool-Age Children: Child and Adolescent Psychiatrists' Adherence to Clinical Practice Guidelines.

To compare child and adolescent psychiatrists' (CAPs) practices in the treatment of preschool children with attention-deficit/hyperactivity disorder (P-ADHD) with published guidelines, and to determine which clinical factors most influence physicians' decisions to initiate pharmacotherapy for P-ADHD. We developed and mailed the Preschool ADHD Treatment Questionnaire (PATQ) to a randomly selected national sample of ∼2200 CAPs trained in the management of ADHD. The PATQ asked CAPs about their approach to clinical management of children ages 4-5 years with ADHD-specifically, how often they recommend parent training in behavior management, medication as a first- or second-line treatment, and which medication they typically choose first. CAPs also rated the perceived importance of 19 different clinical factors in their decision to initiate pharmacotherapy. These 19 factors reflected five child-centered areas of concern: ADHD risk factors, education concerns, social issues (SI), emotional stress, and physical safety (PS). The physicians were asked to rate each factor on a 4-point Likert scale from "not important" to "very important." The final sample consisted of 339 board-certified CAPs. When adherence to the Academy of Child and Adolescent Psychiatry (AACAP) guidelines was defined as initial treatment with behavior management (not medication) and pharmacotherapy specifically with methylphenidate as second-line treatment, only 7.4% of CAPs followed clinical guidelines. Most physicians identified PS as an important or very important factor when initiating pharmacotherapy for P-ADHD (93.4%), followed by educational concerns (EC) (79.9%), emotional stress (69.6%), SI (52.8%), and the presence of risk factors for ADHD (32.7%). The overwhelming majority of CAPs do not follow current AACAP guidelines for treatment of P-ADHD, especially regarding medication initiation and selection. When deciding whether to prescribe medication for P-ADHD, safety and EC were the most important and historical risk factors for ADHD were the least important clinical factors.

Management of ADHD in children and adolescents: clinical audit in a South African setting

Objectives: Attention deficit hyperactivity disorder (ADHD) is common, yet under-recognised and undertreated, particularly in low socio-economic settings. Little is known about compliance to evidence- based guidelines in low- and middle-income countries, and no clinical audits have been published in Africa. We undertook to measure compliance in a South African setting using the National Institute for Clinical Excellence (NICE) guidelines for ADHD as the gold standard to compare compliance and socio-demographic characteristics between two treatment locations in Cape Town and to generate an audit checklist for standardising care.Methods: The study used a sample of 100 randomly selected cases of school-age patients diagnosed with ADHD, at the Division of Child & Adolescent Psychiatry, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa. Fifty cases each from a central and a peripheral clinic location were reviewed retrospectively using audit tools, including 17 audit standards derived from NICE guidelines. We defined compliance as “good” with ≥80%, “fair” with 50–79%, and “poor” with <50% adherence.Results: Compliance was low, with only four audit standards rated as “good”. Physical monitoring was especially poor. The central group received more treatment options and relatively safer monitoring.Conclusions: We recommend introducing structured protocols followed by re-auditing to improve service delivery, and present a checklist for use in future audit cycles.

A Research Framework for Investigating the Benefits of Technology in Treatment and Management of ADHD in Tertiary Students

This paper uses current streams in health research to identify a framework for investigating the use of technology in management of ADHD. The framework incorporates a model based on a multimodal view of treatment options and is aimed at investigating university students with ADHD. The framework includes four main factors: academic performance, symptoms, technology and impacts. A grounded theory approach is described for a potential analytical technique. This framework is intended to address the significant problems of young people with ADHD when attempting to gain professional qualifications.

Attention-Deficit/Hyperactivity Disorder (ADHD) in Children Born Preterm and With Poor Fetal Growth

Attention-deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in childhood, with a recent international pooled prevalence rate of 7.2%. It is associated with significant adverse effects on academic achievement, social competence, community participation, health, and family functioning. The etiology of ADHD is complex, and known risk factors include genetics, environmental toxins, psychosocial adversity, and pre- and perinatal risks, including low birthweight and prematurity. ADHD is the most common sequela of prematurity/very low birthweight for school-age children, with a prevalence rate of 11.5% to 31%. Recent research has focused on ADHD risks associated with being small for gestational age at birth and with late preterm birth. Clinicians working with infants born too early and too small should be able to counsel families about their infants’ prognosis, including the risk for ADHD. In addition, clinicians caring for children born prematurely or those who were small for gestational age should have an increased index of suspicion for ADHD and should be familiar with well-established ADHD screening and management guidelines.

Developing mHealth Remote Monitoring Technology for Attention Deficit Hyperactivity Disorder: A Qualitative Study Eliciting User Priorities and Needs.

BackgroundGuidelines in the United Kingdom recommend that medication titration for attention deficit hyperactivity disorder (ADHD) should be completed within 4-6 weeks and include regular reviews. However, most clinicians think that weekly clinic contact is infeasible, and audits have shown that this timeline is rarely achieved. Thus, a more effective monitoring and review system is needed; remote monitoring technology (RMT) may be one way to improve current practice. However, little is known about whether patients with ADHD, their families, and clinicians would be interested in using RMT.ObjectiveTo explore patients’, parents’, and health care professionals’ views and attitudes toward using digital technology for remote monitoring during titration for ADHD.MethodsThis was a qualitative study, and data were collected through 11 focus groups with adults and young people with ADHD, parents of children with ADHD, and health care professionals (N=59).ResultsAll participant groups were positive about using RMT in the treatment of ADHD, but they were also aware of barriers to its use, especially around access to technology and integrating RMT into clinical care. They identified that RMT had the most potential for use in the ongoing management and support of ADHD, rather than during the distinct titration period. Participants identified features of RMT that could improve the quality of consultations and support greater self-management.ConclusionsRMT has the potential to augment support and care for ADHD, but it needs to go beyond the titration period and offer more to patients and families than monitoring through outcome measures. Developing and evaluating an mHealth app that incorporates the key features identified by end users is required.

Management of ADHD in children and adolescents

Attention deficit hyperactivity disorder (ADHD) is a condition characterised by inattention, hyperactivity and impulsivity that is often diagnosed in early childhood and can interfere with school life and social functioning. This article discusses the assessment of children and adolescents with suspected ADHD, common co‐morbidities and the properties of the drug treatment options available.

Review of international clinical guidelines for adolescents on transition to Adult Mental Health Services and adults with attention-deficit hyperactivity disorder and their application to an irish context.

To review the available clinical guidelines from Canada, North America, Europe and the United Kingdom for the diagnosis and management of attention-deficit hyperactivity disorder (ADHD) for adolescents previously diagnosed in Child and Adolescent Mental Health Services (CAMHS) on transition to Adult Mental Health Services (AMHS) and for adults presenting with a diagnostic query re-ADHD. This article seeks to apply the available guidelines to an Irish context. Various clinical guidelines and consensus statements were identified by a literature search of PubMed, incorporating literature from the past 10 years from English speaking countries and inclusion of any additional guidelines of clinical relevance. A clinical guideline with specific reference for Irish clinicians was proposed for the diagnosis and management of adults presenting for the first time with a diagnostic query re-ADHD and also to include those young adults previously diagnosed in CAMHS on transition to AMHS. ADHD is a lifelong disorder, which if undiagnosed or untreated can lead to significant impairment resulting in a high economic cost for society. Stimulant medication is a first-line treatment option for adults with ADHD; however, some formulations are unlicensed in Ireland. Recent licensing of Atomoxetine, for both adolescents on transition and for adults with newly diagnosed ADHD is a welcome development. Third-line agents are rarely prescribed due to their side effect profiles and are prescribed off-label: It is important to establish clinical guidelines for an Irish context incorporating a biopsychosocial approach. Further discussion amongst clinicians and stakeholders is needed to plan service development.

Methylphenidate-induced priapism in a prepubertal boy.

Byline: Nidhi. Chauhan, Sandeep. Grover, Vandana. Patidar Sir, Methylphenidate is a stimulant medication approved for pharmacological management of attention-deficit hyperactivity disorder (ADHD) in children above 6 years of age. Common side effects of methylphenidate use include insomnia, decreased appetite, weight loss, irritability, and anxiety. Tachycardia and hypertension have also been reported which may be dose related. One of the uncommon side effects of methylphenidate use includes priapism, which is understood as a prolonged full or partial penile erection which is unrelated to sexual stimulus.[sup][1] Following the publication of around 15 case reports of priapism in children (mean age - 12.5 years) associated with the use of stimulants, the US Food and Drug Administration issued a warning in 2013, suggesting an association between priapism and stimulants (methylphenidate and atomoxetine).[sup][2] Most of the cases of priapism seen with the use of methylphenidate have been observed in children aged 8 years or more and adolescents. In this report, we present a case of a 4-year-old male who presented with the symptoms of priapism and review the literature on the association of methylphenidate and priapism. A 4-year-old boy was brought with the chief complaints of rubbing his penis repeatedly after started using methylphenidate. Detailed evaluation of his history revealed that he was born out of a wanted, planned pregnancy of nonconsanguineous marriage by in vitro fertilization. He was delivered by an elective cesarean section, without any antenatal or perinatal complication. He cried immediately after birth, his birth weight was ~ 2.2 kg, and breastfeeding was instituted immediately after birth. He developed transient physiological jaundice which resolved in 2–3 days without any phototherapy. He had delayed development of milestones in all domains of fine motor, gross motor, speech, language, and communication. He started walking by the age of 21/2 years. By 3 years of age, when he was sent to play school, he was noticed to be restless, would not sit still even for 5 min, would be always on the go, keep fiddling with objects in his reach, playing with them for few minutes, and then throwing them away. At the play school too, he would not sit on his seat, instead kept on roaming in the entire class, disturb other children, despite repeated instructions of teachers to not to do so. If made to sit forcibly, he would keep on moving his limbs and appear restless. He would not pay attention to what was being taught in class, instead keep on looking outside the windows and doors. When teachers would try to engage him in any activity such as drawing, he would finish it fast and then interrupt other children in their work. He had difficulty in waiting for his turn while playing; often insist to let him play first. He would keep talking something or the other or singing a rhyme despite being told not to do so. He often interrupted others during conversations. In addition, he often lost his belongings at school. As a result, he was not able to learn and lagged behind his peers. Parents thought that things would improve as he grew but all these behaviors kept on increasing. Due to his behavioral problems, there were frequent complaints from the school and this led to a psychiatric consultation. He was evaluated by a psychiatrist, was diagnosed with ADHD, and was started on tablet methylphenidate (immediate release) 5 mg/day in the morning. Over the period of the next 2–3 months, there was about 50% reduction in his hyperactivity. However, after about 3 months of continuing methylphenidate, the family members observed him to be rubbing his penis repeatedly, many times a day, each time for 5–10 min, especially few minutes to half an hour after being administered the morning dose of methylphenidate. When family members would ask him to stop, he would not stop and it would appear that he was unable to control it. …

The Effects of Training: Teacher and Behavioural Intervention for ADHDH Delivered in School

Background: ADHD is frequently associated with an impact in the field of education since 30% of ADHD children are in school failure. Although the French recommendations and international recommended the establishment of educational development in class in the management of ADHD, this educational development are rarely used and few study measured the effects on the evolution of ADHD. Objective: The main objective of this study is to measure the effectiveness of CBT tools and the impact of teachertraining has this tools on the severity of ADHD symptoms (ADHD-RS scale score). The secondary objectives are to reduce anxiety and depression symptoms of ADHD children, improve self-esteem of the children and improve the neurocognitive skills. Method: 34 children included between 6 and 11 years present an ADD/ADHD and/or severe learning disabilities with educational impact (educational assessment and dropout questionnaire school). The experimental group is composed of 17 ADHD children, in a specialized school, where teachers have received training on tools TCC. The control group is composed of 17 children with ADHD, matched to the experimental group in terms of age, sex, severity of the disorder and its comorbidities. These ADHD children are educated in a mainstream school with the usual recommendations in terms of educational development (given by the HAS). Results: Our results find a difference not significant on the score of ADHD-RS and on the score self-esteem Rosenberg scale but show a significant decrease of phobic anxiety and depressive symptoms and on the neurocognitive test among school children in the school whose teachers have benefited from the training. Discussion: Our study highlights significant and positive effects of these methods on the comorbidities associated with ADHD disorder (anxiodepressive disorder and selfesteem).

Optimal management of ADHD in older adults.

BackgroundThe manifestation of attention-deficit/hyperactivity disorder (ADHD) among older adults has become an interesting topic of interest due to an increasing number of adults aged 50 years and older (≥50 years) seeking assessment for ADHD. Unfortunately, there is a lack of research on ADHD in older adults, and until recently only a few case reports existed.MethodA systematic search was conducted in the databases Medline/PubMed and PsycINFO in order to identify studies regarding ADHD in adults ≥50 years.ResultsADHD persists into older ages in many patients, but the prevalence of patients fulfilling the criteria for the diagnosis at age ≥50 years is still unknown. It is reason to believe that the prevalence is falling gradually with age, and that the ADHD symptom level is significantly lower in the age group 70–80 years than the group 50–60 years. There is a lack of controlled studies of ADHD medication in adults ≥50 years, but this review suggests that many patients aged ≥50 years experience beneficial effects of pharmacological treatment. The problem with side effects and somatic complications may rise to a level that makes pharmacotherapy for ADHD difficult after the age of 65 years. Physical assessment prior to initiation of ADHD medication in adults ≥50 years should include a thorough clinical examination, and medication should be titrated with low doses initially and with a slow increase. In motivated patients, different psychological therapies alone or in addition to pharmacotherapy should be considered.ConclusionIt is essential when treating older adult patients with ADHD to provide good support based on knowledge and understanding of how ADHD symptoms have affected health, quality of life, and function through the life span. Individualized therapy for each elderly patient should be recommended to balance risk–benefit ratio when pharmacotherapy is considered to be a possible treatment.