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ADHD, 1.04 (V) New Findings and Treatments for ADHD - What we have Learned and What We

Welcome to Module 1. In this module, we're gonna discuss what ADHD is, how to identify it, the nature of the disorder, its prevalence. We'll talk a little bit about the causes of ADHD. And you'll notice we don't spend a whole lot of time on these defining features. Because for a child who's having struggles related to ADHD, and their family as a provider, I want to move the treatment as fast as possible. So the remainder of the modules are gonna focus on evidence-based assessments and then how to help kids with ADHD in home and in school. But in Module 1, the first thing we gotta do is define what ADHD is. ADHD is characterized by developmentally inappropriate levels of inattention, hyperactivity, and impulsivity. So relative to other kids of the same age the individual with ADHD is doing these things more than we would expect. So what is developmentally inappropriate for a four year old in terms of an inattention, hyperactivity, impulsivity is going to be different if we're talking about a 14 year old. And maybe different if we're talking about an adult with ADHD who's a 44 year old. Importantly, the symptoms in and of themselves are typically not the things that trigger treatment efforts. So no parent says, my child does not sustain attention, my child's distractable, my child interrupts or blurts out answers before questions have been completed, and that's why I want treatment. Those types of behaviors cause impairment in daily life function. They make it hard for the teacher to manage their class, and may make the parent frustrated or stressed out, because their child needs many more reminders to do even everyday activities, like getting ready for school or getting ready for bed. It may cause problems in peer relationships where children aren't getting invited to class birthday parties or aren't chosen to be part of the teams playing in recess at school. Those are areas of impairment. They occur because a child's having these inappropriate levels of inattention, hyperactivity, and impulsivity, but it's an important distinction to make. Because it's gonna be improvements in those areas of impairment that's really gonna be what makes a parent satisfied with treatment. And ultimately make the child be more successful and function better in their everyday activities. Importantly, the symptoms of ADHD have to be pervasive, so they have to occur in more than one setting. At home and in school, perhaps at school and in an organized activity like scouts or sports. The symptoms have to be chronic so they have to be occurring for at least six months or longer. They also have to be long standing so the current diagnostic criteria states that the symptoms have to be present from at least 12 years of age. So somebody that has a late adolescent or adult onset of these symptoms we might wonder about a different diagnosis or a different cause for what was happening. Because ADHD's typically chronic, and of course with at least some markers present early in childhood. A lot of people have said, well what causes ADHD? Is it just based on our kinda fast paced lifestyles, all the technology that's infused into children's lives. In fact, if you look back in time, there's some evidence that individuals noticed the behaviors that we now label as ADHD, at least in the 18th century. So there's a German psychiatrist that had a story about fidgety Phillip where Phillip does all the things we might expect a child with ADHD would do. He has trouble sitting down through a meal and because of that he's often spilling his milk. His parents get upset with him because he's always interrupting them and being loud in the home. He rocks back and forth on his chair rather than sitting still in it. I think this is an indicator that kinda illustrates to all of us that these are behaviors that have been around for a long time. Perhaps our contexts have made them more pronounced. So nowadays children are asked to sit in a classroom for six hours a day. They're asked to sit and do seat work, perhaps, for 40 minutes to an hour. And when sitting, they're in large groups of children where there's not a whole lot of individual attention. If you wanted to create an environment where ADHD behaviors would become more pronounced and perhaps more apparent. You would create the school system that we have in this country. Further if you wanted to make it even worse you'd create a middle school system. Where now on top of that you layer needing to manage multiple teachers expectations, long-term and short-term homework assignments, organizing materials that are for each individual classes in a book bag or locker. All of those sorts of things are going to tax all children but particularly with a child with difficulties related to ADHD. Another key question that comes up is, is ADHD over-diagnosed? It just seems like the diagnostic rate has exploded. In fact, it's unclear whether it's over-diagnosed. Some studies suggest that the disorder may be actually under-diagnosed, depending on the sample and the setting that the child is in. We did a study a few year ago where we asked teachers how many kids were identified to them as having ADHD? And they said about 1 per class of 20, so that's about 5% of kids. We also asked them how many kids do you suspect has ADHD, but haven't been identified to you yet? And they identified another 5% of kids. The worldwide prevalence of ADHD is estimated to be about 7 to 8%. And so our studies suggest that only about half as many kids, who teachers would say have the behaviors that suggest ADHD are actually diagnosed or identified. Sadly, if teachers were from schools with a high rate of free and reduced lunch, where they were serving students from poor neighborhoods or a lower socioeconomic strata, those children were especially unlikely to be diagnosed and receiving any treatment for ADHD. In a moment we're gonna move to the rest of Module 1, when we talk a bit about the causes of ADHD. And then, we'll transition into assessment approaches and eventual treatment planning and evaluation.



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Welcome to Module 1. In this module, we're gonna discuss what ADHD is, how to identify it, the nature of the disorder, its prevalence. We'll talk a little bit about the causes of ADHD. And you'll notice we don't spend a whole lot of time on these defining features. Because for a child who's having struggles related to ADHD, and their family as a provider, I want to move the treatment as fast as possible. So the remainder of the modules are gonna focus on evidence-based assessments and then how to help kids with ADHD in home and in school. But in Module 1, the first thing we gotta do is define what ADHD is. ADHD is characterized by developmentally inappropriate levels of inattention, hyperactivity, and impulsivity. So relative to other kids of the same age the individual with ADHD is doing these things more than we would expect. So what is developmentally inappropriate for a four year old in terms of an inattention, hyperactivity, impulsivity is going to be different if we're talking about a 14 year old. And maybe different if we're talking about an adult with ADHD who's a 44 year old. Importantly, the symptoms in and of themselves are typically not the things that trigger treatment efforts. So no parent says, my child does not sustain attention, my child's distractable, my child interrupts or blurts out answers before questions have been completed, and that's why I want treatment. Those types of behaviors cause impairment in daily life function. They make it hard for the teacher to manage their class, and may make the parent frustrated or stressed out, because their child needs many more reminders to do even everyday activities, like getting ready for school or getting ready for bed. It may cause problems in peer relationships where children aren't getting invited to class birthday parties or aren't chosen to be part of the teams playing in recess at school. Those are areas of impairment. They occur because a child's having these inappropriate levels of inattention, hyperactivity, and impulsivity, but it's an important distinction to make. Because it's gonna be improvements in those areas of impairment that's really gonna be what makes a parent satisfied with treatment. And ultimately make the child be more successful and function better in their everyday activities. Importantly, the symptoms of ADHD have to be pervasive, so they have to occur in more than one setting. At home and in school, perhaps at school and in an organized activity like scouts or sports. The symptoms have to be chronic so they have to be occurring for at least six months or longer. They also have to be long standing so the current diagnostic criteria states that the symptoms have to be present from at least 12 years of age. So somebody that has a late adolescent or adult onset of these symptoms we might wonder about a different diagnosis or a different cause for what was happening. Because ADHD's typically chronic, and of course with at least some markers present early in childhood. A lot of people have said, well what causes ADHD? Is it just based on our kinda fast paced lifestyles, all the technology that's infused into children's lives. In fact, if you look back in time, there's some evidence that individuals noticed the behaviors that we now label as ADHD, at least in the 18th century. So there's a German psychiatrist that had a story about fidgety Phillip where Phillip does all the things we might expect a child with ADHD would do. He has trouble sitting down through a meal and because of that he's often spilling his milk. His parents get upset with him because he's always interrupting them and being loud in the home. He rocks back and forth on his chair rather than sitting still in it. I think this is an indicator that kinda illustrates to all of us that these are behaviors that have been around for a long time. Perhaps our contexts have made them more pronounced. So nowadays children are asked to sit in a classroom for six hours a day. They're asked to sit and do seat work, perhaps, for 40 minutes to an hour. And when sitting, they're in large groups of children where there's not a whole lot of individual attention. If you wanted to create an environment where ADHD behaviors would become more pronounced and perhaps more apparent. You would create the school system that we have in this country. Further if you wanted to make it even worse you'd create a middle school system. Where now on top of that you layer needing to manage multiple teachers expectations, long-term and short-term homework assignments, organizing materials that are for each individual classes in a book bag or locker. All of those sorts of things are going to tax all children but particularly with a child with difficulties related to ADHD. Another key question that comes up is, is ADHD over-diagnosed? It just seems like the diagnostic rate has exploded. In fact, it's unclear whether it's over-diagnosed. Some studies suggest that the disorder may be actually under-diagnosed, depending on the sample and the setting that the child is in. We did a study a few year ago where we asked teachers how many kids were identified to them as having ADHD? And they said about 1 per class of 20, so that's about 5% of kids. We also asked them how many kids do you suspect has ADHD, but haven't been identified to you yet? And they identified another 5% of kids. The worldwide prevalence of ADHD is estimated to be about 7 to 8%. And so our studies suggest that only about half as many kids, who teachers would say have the behaviors that suggest ADHD are actually diagnosed or identified. Sadly, if teachers were from schools with a high rate of free and reduced lunch, where they were serving students from poor neighborhoods or a lower socioeconomic strata, those children were especially unlikely to be diagnosed and receiving any treatment for ADHD. In a moment we're gonna move to the rest of Module 1, when we talk a bit about the causes of ADHD. And then, we'll transition into assessment approaches and eventual treatment planning and evaluation.


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