ATTENTION DEFICIT HYPERACTIVITY DISORDER IN CHILDREN, ADOLESCENTS, AND ADULTS

Efficacy and Safety of Melatonin Treatment in Children with Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder-A Review of the Literature

Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are neurodevelopmental disorders with disturbed melatonin secretion profile and sleep problems. The growing incidence of ASD and ADHD inspires scientists to research the underlying causes of these conditions. The authors focused on two fundamental aspects, the first one being the presentation of the role of melatonin in ASD and ADHD and the second of the influence of melatonin treatment on sleep disorders. The authors present the use of melatonin both in the context of causal and symptomatic treatment and discuss melatonin supplementation: Dosage patterns, effectiveness, and safety. Sleep disorders may have a different clinical picture, so the assessment of exogenous melatonin efficacy should also refer to a specific group of symptoms. The review draws attention to the wide range of doses of melatonin used in supplementation and the need to introduce unified standards especially in the group of pediatric patients.

Web-Based Intervention for Teachers of Elementary Students With ADHD: Randomized Controlled Trial

OBJECTIVE

To test the acceptability, satisfaction, and effectiveness of a web-based intervention for teachers of elementary school-aged children with ADHD.

METHOD

Elementary classroom teachers (N = 58), along with their students with ADHD, participated in a randomized controlled trial. The program consisted of six sessions that included evidence-based intervention strategies for reducing ADHD symptoms and impairment in the classroom setting. Teachers also had access to a moderated Discussion Board and an online ADHD coach. Questionnaire data were electronically collected from teachers and parents pre-intervention, post-intervention (6 weeks), and after an additional 6-week follow-up.

RESULTS

Intent-to-treat analyses found significant improvements based on teacher (but not parent) reports of core ADHD symptoms and impairment for the Teacher Help for ADHD treatment group. Teachers reported a high level of acceptability and satisfaction.

CONCLUSION

Web-based ADHD interventions have the potential to reduce the barriers to treatment utilization and implementation that are common problems for school-based ADHD interventions.

ADHD Diagnosis: As Simple As Administering a Questionnaire or a Complex Diagnostic Process?

OBJECTIVE

The present study investigated the validity of using the Conners' Teacher and Parent Rating Scales (CTRS/CPRS) or semistructured diagnostic interviews (Parent Interview for Child Symptoms and Teacher Telephone Interview) to predict a best-practices clinical diagnosis of ADHD.

METHOD

A total of 279 children received a clinical diagnosis based on a best-practices comprehensive assessment (including diagnostic parent and teacher interviews, collection of historical information, rating scales, classroom observations, and a psychoeducational assessment) at a specialty ADHD Clinic in Truro, Nova Scotia, Canada. Sensitivity and specificity with clinical diagnosis were determined for the ratings scales and diagnostic interviews.

RESULTS

Sensitivity and specificity values were high for the diagnostic interviews (91.8% and 70.7%, respectively). However, while sensitivity of the CTRS/CPRS was relatively high (83.5%), specificity was poor (35.7%).

CONCLUSION

The low specificity of the CPRS/CTRS is not sufficient to be used alone to diagnose ADHD. (J. of Att. Dis. 2016; 20(6) 478-486).

Validating the Behavior Rating Inventory of Executive Functioning for Children With ADHD and Their Typically Developing Peers

The Behavior Rating Inventory of Executive Functioning (BRIEF) has been widely used both clinically and in research for measuring executive functioning (EF) in children with attention-deficit hyperactivity disorder (ADHD). This study examined the concurrent validity of the BRIEF (both parent and teacher ratings) compared to performance-based measures of EF in children with ADHD compared to typically developing (TD) children. The authors assessed 20 children with ADHD and 20 TD controls on 4 EF domains-working memory, planning, inhibition, and set shifting-using the BRIEF and performance-based measures of EF. Children (aged 8-12 years old) with ADHD demonstrated more EF impairment than their TD peers on both questionnaire- and performance-based measures. Ratings on questionnaire- and performance-based measures did not uniquely correlate with each other. Questionnaire-based measures were better at discriminating between children with ADHD and TD children, specifically BRIEF parent ratings, and discrimination depended mostly on the Working Memory, Plan/Organize, and Inhibit subscales. The BRIEF has clinical utility for discriminating between children with ADHD and their TD peers; however, some limitations exist for interpretation of the BRIEF, and it should be used with caution in the assessment and diagnosis of ADHD.

Barriers to evidence-based treatment for children with attention-deficit/hyperactivity disorder

A number of evidence-based treatments are available for attention-deficit/hyperactivity disorder (ADHD), including pharmacological, psychosocial, or a combination of the two treatments. For a significant number of children diagnosed with ADHD, however, these treatments are not utilized or adhered to for the recommended time period. Given that adherence to treatment regimens is necessary for reducing the symptoms of ADHD, it is crucial to develop a comprehensive understanding of why adherence rates are so low. The current review examines the literature to date that has directly explored utilization and adherence issues related to the treatment of ADHD in order to identify the key barriers to treatment. This review focused on four main factors that could account for the poor rates of treatment utilization and adherence: personal characteristics (socio-demographic characteristics and diagnostic issues), structural barriers, barriers related to the perception of ADHD, and barriers related to perceptions of treatment for ADHD. This review included 63 papers and covered a variety of barriers to treatment that have been found in research to have an impact on treatment adherence. Based on this review, we conclude that there are complex and interactive relationships among a variety of factors that influence treatment utilization and adherence. Four main gaps in the literature were identified: (1) there is limited information about barriers to psychosocial interventions, compared to pharmacological interventions; (2) there is a limited variety of research methodology being utilized; (3) treatment barrier knowledge is mostly from parents' perspectives; and (4) treatment utilization and treatment adherence are often studied jointly. Information from this review can help practitioners to identify potential barriers to their clients being adherent to treatment recommendations.

Nova Scotia Teachers’ ADHD Knowledge, Beliefs, and Classroom Management Practices

Attention-deficit/hyperactivity disorder (ADHD) has a significant impact on children’s social, emotional, and academic performance in school, and as such, teachers are in a good position to provide evidence-based interventions to help ensure optimal adjustment of their students. The current study examined teachers’ knowledge and beliefs about ADHD, their self-reported use of evidence-based instructional and behaviour management strategies in the classroom, and the relationships between knowledge, beliefs, and classroom practices. It was expected that teachers would have a moderate amount of knowledge about ADHD, mixed positive and negative beliefs about ADHD, that they would regularly use less intensive evidence-based behaviour management strategies, and that more knowledge and positive beliefs about ADHD would be correlated with higher use of effective classroom practices. Web-based questionnaires were completed by 113 teachers from six school boards across Nova Scotia. Results indicated that the mean teacher knowledge score was ~68% and that they had more knowledge about symptoms/diagnosis of ADHD and less knowledge about general ADHD facts and about evidence-based treatments. Teachers had slightly more positive than negative beliefs about ADHD and reported occasional use of evidence-based instructional and behaviour management practices in their classrooms. There was a significant correlation between teachers’ beliefs about ADHD and their use of evidence-based behaviour management practices, but there was no significant correlation between specific ADHD knowledge and classroom practices. Information gained from this study has implications for the content of ADHD teacher training and professional development programs as well as for school psychologists and those in teacher consultation roles.

Attention deficit hyperactivity disorder in offenders and the need for early intervention

Attention deficit hyperactivity disorder (ADHD) can be, for some people, a pathway to prison. Intervening at an early age may prevent delinquency. Generally, these interventions consist of a combination of medication, cognitive-behavioral therapy, family intervention, and educational support. Despite these interventions, some people with ADHD still develop antisocial and criminal behavior. This article examines the link between ADHD and delinquency, and reviews relevant treatments.

A framework for the assessment and treatment of sleep problems in children with attention-deficit/hyperactivity disorder

Children with attention-deficit/hyperactivity disorder (ADHD) have high rates of sleep problems and sleep disorders. It is critical that pediatricians assess for sleep problems during the course of ADHD assessment and when treating children with stimulant medication. Sleep must be considered in the differential diagnosis and in terms of comorbidity with ADHD. The most common sleep problem in children with ADHD is insomnia, and the first line of treatment should be the implementation of behavioral interventions rather than medication. More research is needed to determine if children with ADHD respond to behavioral interventions in a similar manner as typically developing children.