I need someone to take my weekly short online quiz

3/7/2019

1

ADHD TREATMENTS

 Used to treat ADHD since the 1930s

 Use in North America tripled from 1990-2007  Currently taken by over 3.5 million children and

adolescents in the US (6% of 4- to 17-year-olds)

 Stimulant use 5 times higher in North America than in the rest of the world  But worldwide use is also increasing

 Alter activity in fronto-striatal brain circuit by affecting neurotransmitters important to this region

Medication - Stimulants

3/7/2019

2

Positive and Negative Effects

Side effects in 30-40%

Also: • Insomnia • Height loss

(~1/2 inch)

3/7/2019

3

Stimulant Efficacy

 Stimulants are highly effective for 80% youth  Increases in sustained attention, impulse control, and

persistence of work effort

 Decreases in task-irrelevant activity and noisy/disruptive behaviors

 MTA study (1999) included almost 600 7-9 year- old children diagnosed with ADHD  Compared: community care, behavior treatment (parent

management training), medication management, and combined medication and therapy

MTA Study Results

3/7/2019

4

But long-term effects less clear

 Effects only temporary  Occur only while medication is taken, many discontinue

 Considered safe, but long-term effects on brain (positive or negative) not clearly known  Some evidence that stimulants help to normalize structural

abnormalities and functional connections in brain

 But could also have unknown negative effects

 MTA study long-term findings disappointing  Molina et al. (2009) 8-year follow-up shows that benefits

decline or cease for all groups (meds, behavioral, combo)

 But most stopped taking their medication

 Parent “classes”:  Taught to understand symptoms and biological basis of ADHD

 Taught behavior management techniques  i.e. time-out

 How to give commands

 Noticing good behavior

 Behavior charts

 Home “token economy”

Parent Management Training (PMT)

3/7/2019

5

 School-based interventions for ADHD have received considerable support

 “Good teaching”

 Behavior charts (daily report cards) with rewards and response-cost procedures used to reduce disruptive or off-task behaviors

 i.e. red, yellow green zones, or tokens

Educational Interventions

Educational Interventions (cont’d)

 Accommodations for documented disability  More individualized attention

 Seating closer to teacher/away from distractions

 Extra time

 Homework reductions

 Therapeutic staff support (TSS)

3/7/2019

6

Things that are sometimes helpful, but less supported

 Social skills training

 Cognitive behavior therapy (CBT) to cope with self- esteem, explore self-defeating patterns of behavior, and learn alternative ways to handle emotions

 Support groups

 Family therapy

 Psychoeducation

Not scientifically substantiated

 Fads?  Treatment for inner ear problems,

allergies, yeast infections

 Chiropractic adjustment and bone alignment

 Eye training, special colored glasses

ADHD Glasses $39.95

3/7/2019

7

What about diet?

 Fatty acid supplementation (i.e. fish oil)  Omega-3 fatty acids build brain cell membranes, reduce brain

inflammation, and promote new brain cell formation

 Small effect, but could add to other treatments

 Restricted or modified diets: also small effect, but could be useful for kids with food sensitivities  Oligoantigenic diet – eliminates common food sensitivity triggers:

 Egg, beef, nuts, fish, shellfish, citrus, chocolate, soda, corn, cinnamon, dairy, wheat, rye, barley, soy, legumes, tomato

 Consider dietetics consultation

What about brain training?

 Cognitive training  Uses computer “games”

 Train EF deficits (working memory and attention)

 Show some improvements in EF

 Neurofeedback  Uses visualization of EEG brain waves

to teach children to increase alertness, attention, and impulse control  Increase beta/decrease theta

 Show small but significant effects

3/7/2019

8

Case Study: Colby T.

 What symptoms of ADHD does Colby present with? Does he have enough symptoms to meet diagnostic criteria for ADHD? If so, which subtype?

 What are some possible causes/risk factors for his ADHD?

 What treatment recommendations would you make? Be specific.

 Would you recommend any school accommodations? Be specific.