Welcome to Abnormal
Child Psychology
Jill M. Norvilitis, Ph.D.
Issues that research in this field
addresses
What constitutes normal/abnormal
behavior for kids of different ages and
both genders.
 Identifying causes and correlates of
abnormal child behavior
 Making predictions about long term
outcomes
 Developing and evaluating methods for
treatment and prevention
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Unique to disorders of childhood
Often not clear whose problem it is
 Problems often involve failure to show
expected developmental progress
 Many problems are not entirely abnormal
 Interventions are often intended to
promote further development
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Developmental Psychopathology
Multiply influenced—psychological,
sociocultural, biological
 Patterns of behavior, emotions, cognitions
that are abnormal, disruptive, distressing
 Either to person or to others around the
person
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Defining Psychological Disorders
Person shows some degree of distress
 Behavior indicates some degree of
disability
 Distress or disability increases risk of
further suffering or harm
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Keys to Remember
Importance of relationships
 Labels and stigma
 Competence
 Frequency/intensity of problems
 Multifinality
 Equifinality
 Accurate views of what is normal
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Risk Factors
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Characteristics, events, or processes that
increase risk for the development of psych
problems
Categories
Some risk factors are more predictive of
problems than others
Vulnerability varies
Risk accumulates
Some connection between risk factors and
specific disorders
Number of risk factors is important
Resiliency/Protective Factors
Characteristics, events, or processes that
protect an individual from the dev of
psychological problems
 Personal attributes—intelligences, selfconfidence, etc
 Family strengths
 Support from outside the family
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How common are problems?
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Epidemiology
Prevalence—total # of cases at a given time
Incidence--# of new cases in a given period
Between 1/8 and 1/5 have clinical problem that
impairs functioning
10-20% meet diagnostic criteria
10% of those with problems receive tx
Youngest ¼ of population receives 1/9 tx dollars
Theories and Causes
Theory—systematic set of statements designed
to help organize, analyze, explain, and predict
 Purpose…
 A good theory should
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Account for the majority of existing research data
Give relevant explanations/logical reasons
Be able to be tested for accuracy
Predict new events, incorporate new info
Be parsimonious
Be logically consistent
Etiology
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Underlying assumptions
– Behavior is multiply determined
– Child and environment are interdependent—this dynamic
interaction is called a transaction
– Abnormal development involves continuity and discontinuity
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Adaptational failure—failure to master or progress in
accomplishing developmental milestones
Developmental psychopathology is a macroparadigm
that draws on multiple perspectives
Freud
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Deterministic
Mental processes are often unconscious
Conflict model—id/ego/superego
Stages
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Oral
Anal
Phallic
Latency
Genital
Advantages to this theory
– Helped establish field of psychology
– Emphasized importance of childhood
Updates to Psychoanalytic Theory
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Object relations theory—importance of
relationship with caregiver is key.
– Melanie Klein—healthy relationships as infants
lead to healthy relationships as adults
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Attachment theory—Bowlby 1969,
Ainsworth, 1978
– Secure, ambivalent, avoidant, disorganized
Biological Model
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Hippocrates—somatogenesis
Late 1800s, bio causes for everything
Varies by genetic and constitutional factors,
neuroanatomy, rates of maturation
Neural plasticity—malleability
It is rare to find a disorder that is completely bio in
origin
Diathesis-stress model
Genetic Contributions
ADHD—multiple genes, Huntington’s
Chorea—single gene
 Heritability—proportion of variation in a
given trait that is genetic/inherited
 Concordance rates—MZ, DZ, adoption
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Neurobiological Contributions
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Brain structure & function
– Many locations, particularly frontal lobes
– Damage to brain pre or post-natally
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Accident
Illness
Malnutrition
Toxic substances
Neurotransmitters
– Implicated in many disorders
– Not as well understood in kids
Psychological Factors
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Emotional influences
– Reactivity—differences in threshold and
intensity of expression of emotion &
regulation
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Temperament
– Easy—positive affect and approach
– Difficult—negative affect or irritability
– Slow to warm—fearful or inhibited
Behavioral Theories
The connection with developmental
psychopath really began with Watson
 Operant conditioning
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– Some disorders are more linked to behavioral
contingencies than others. For example,
phobias, enuresis, oppositional problems
We will talk about this theory more when
we discuss tx
 Social learning theory
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Cognitive Behavioral Theories
Observable behavior can be influenced by
mental processes
 Particularly useful as a theory for
depression (but others as well)
 Automatic thoughts—immediate,
unquestioned thoughts when faced with a
new or recurrent situation
 Cognitive distortions-help develop and
maintain symptoms
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Family Systems Theory
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The child is only the identified
Child’s problems are a reflection of family
problems or problems in marital relationship
Families want to maintain homeostasis
Family structures and alliances are often
disrupted
Communication is also often disrupted
Can be enmeshed or disengaged
Bronfenbrenner’s Ecological
Systems Theory
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There are many systems and settings to be
considered when trying to understand the
etiology of problems
Macrosystem—beliefs and values of the culture
Exosystem-social structures
Mesosystem-interconnections between various
community systems
Microsystem-child’s immediate environment
Ontogenic development—the child’s own internal
development and adaptation
Ethics in Working with
Children and Families
Competence—can’t just deem yourself
competent
 Multiple relationships—also known as dual
relationships
 Informed consent and assent—must inform
about the kind of therapy or assessment
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– Also—must clarify who is the client and what role
each person plays
Confidentiality and Limits to
Confidentiality
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Suicide, homicide, and abuse of a dependent
person
Tarasoff—duty to warn
Involuntary commitment
Children’s legal rights in treatment decisions
Children can’t be forced to participate, but can
be forced to sit there
Research Ethics
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IRBs
Non-harmful procedures
Incentives
Deception
Anonymity
Mutual responsibilities
Jeopardy
Informed consent and assent
Confidentiality
Informing participants of results
Research in Abnormal Child
Psychology
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Time frame of the study
– Cross-sectional—possible cohort effects
– Longitudinal designs—time consuming,
expensive, drop outs, historical factors
– Accelerated longitudinal designs aka
sequential designs
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Where do we get participants—schools,
clinics, hospitals, community, laboratory
Just a Bit on Freud Himself
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Born 5/6/1856 in Freiburg, Moravia (now Pribor, Czech) to a 40 yo wool
merchant father on his 2nd marriage—remote and authoritarian.
Mother—Amalie—more nurturing
Had 2 older ½ brothers, but had nephew 1 yr older
1859 moved to Leipzig for economic reasons
1860—to Vienna where Freud stayed until 1938 when Nazis came
Had brother Julius—one year younger, died in 1858
Sister Anna
Age 17—moved by curiosity about human concerns
Became physician in his 20s
Trained as a neurologist under Charcot and then under Breuer.
With Breur treated Anna O in 1895, began to develop own ideas after that
Dora
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Dora began to suffer from a hysterical cough and loss of voice
Threatened to kill herself
Freud found multiple sexual conflicts
Dora’s father was having an affair with Frau K, whom Dora had
adored
Dora envied both of the lovers and felt betrayed by both
Frau K’s husband was attracted to Dora and Herr K made advances
to Dora
Dora’s father didn’t believe her, but Dora was also attracted to Herr
K and had fantasized marrying him but Dora learned he’d been
having an affair with the governess and she was mad.
But Dora quit tx abruptly
Dora’s Outcome
Freud had had high hopes for the tx. Wrote it up in only
3 wks
 Book was written as a follow up to Freud’s dream book.
Not intended to convey every treatment utterance.
 In April 1902, 15 mos after termination, Dora
reappeared. She had improved. Had visited Ks—got
Frau K to admit affair and Herr K to admit advances.
 In Oct. 1901—1 yr after beginning therapy, Dora lost her
voice again after she bumped into Herr K on the street.
He stopped and was run over by a carriage. He survived
and her voice got better.
 Later Dora married and Freud wrote that she was
“reclaimed by the realities of life”
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The Real Dora
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Ida Bauer, born 1882 in Vienna of Bohemian Jewish
ancestry
Dora's father, Philip Bauer, was a wealthy textile
manufacturer.
Dora's brother, Otto Bauer, became a leading figure in
the Austrian Social Democratic Party, a Marxist theorist
who specialized in the question of nationality and
nationalism.
Dora married in 1903 at the age of twenty-one.
She continued to suffer from a variety of psychosomatic
ailments throughout her life.
One of her few satisfactions, a later analyst reported,
was that she knew herself to be the subject of one of
Freud's most famous case histories.
Hysteria
Originally “wandering uterus”—therefore
only women
 Multiple somatic complaints without any
obvious medical cause
 Overtime took on connotation of
exaggerated or overly dramatic
 Take overpowering anxiety and convert it
into sx (conversion hysteria)
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Assessment
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Developmental considerations: age, gender, cultures
Many purposes of assessment
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Determine levels of problematic emotions and behaviors
Determine range of problematic emotions and behaviors
Help identify any appropriate diagnoses
Identify strengths and competencies
Evaluate efficacy of treatment by assessing before, during, and
after tx
– Determine etiological factors of problem
– Identify children at risk for dev problems in the future
– Establish prognosis and tx planning
Effective Assessment
(Prevatt, 1999)
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Prereferral used—may be able to intervene before an assessment
Ecologically based assessment
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Multimodal
Emphasis on family/school environment
Avoidance of label/pathology based approach
Emphasis on why things occur
Outcome-based
Adherence to legal and ethical guidelines
Uses tests with good psychometric properties—reliable, valid,
adequate normative data, cost effective
Intervention focused
– Strengths and weaknesses
– Learning-based strategies, school, family and community strategies
– ? need for consultations
Must choose between depth and breadth
in assessment
 Should be multimethod—using several
types of techniques and should use
multiple informants
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Interviews
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The most common technique
Unstructured, semi-structured,
structured
Rapport
Weaknesses of unstructured
interviews—not very reliable, may
go off on tangents as they come
up
Structured and semi-structured
are more reliable.
May be used in combination.
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Should cover
– Parent and child
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History of current difficulties
Child’s educational hx
Home environment
Expectations for child
Child’s strengths and
competencies
– Parent only
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Details of pregnancy and birth
Developmental hx
Medical hx
Family characteristics and hx
Child’s interpersonal skills
– Child only
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Job hx and goals
Sexual involvements
Friendships
Illicit substances
Behavioral Assessment
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Behavioral observation
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structured or unstructured
look for antecedents and consequences
most often done in schools
A-Antecedent, B-Behavior, C-Consequences
Functional assessment
– evaluation of actual behaviors and child’s ability to
perform these
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Self-monitoring
– allows child to keep track of a specific behavior by
recording its occurrence
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Concern with all of these techniques: reactivity
Checklists and Rating Scales
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Not very expensive, widely used
Most take 5-15 minutes
Broad measures: CBCL, TRF, YSR
Specific measures: CDI, Conners, STAI-kiddie
Concern—parents’ pathology may increase ratings of
kids’ problems. Kids may downplay problems.
When looking at CBCL, TRF, YSR
– Those in similar roles (parent-parent) corr about .6, adults in
different roles (parent-teacher) corr about .3, children with
adults corr about .2
– All corrs are higher for externalizing.
– Why?
Personality Assessment
Ask about functioning without asking about
specific behaviors
 Personality inventories—MMPI-A
 Projective measures
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– Ambiguous stimuli onto which individuals project
ideas and feelings.
– Many types-Rorschach, TAT/CAT/RAT, DAP.
Intellectual and Educational
Assessment
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Intelligence tests
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Most commonly employed assessment device beyond interviews
WISC-IV—10 mandatory, 5 supplementary scales.
Stanford-Binet
Both M= 100 sd=15 or 16.
Criticisms
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Cultural loading and school based quality of some tests
Focus on speed of responses to detriment of methodical kids
View of IQ as rigid and inflexible
Using IQ tests makes IQ real and not a construct.
Educational tests—Woodcock-Johnson, WIAT, WRAT
Neuropsychological Testing
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Primary purpose
– Find the implications of brain-related deficits and
lesions
– Much more specific than broader measures
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Areas
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Perceptual/sensory
Motor functions
Verbal functions/language/communication
Attention/learning/processing
Non-verbal functions
Strengths and Weaknesses
of Testing
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Strengths of standardized testing
– Many tests—finding a good one in your area
shouldn’t be hard
– Identifies strengths and weaknesses from a
variety of perspectives
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Weaknesses of testing
– Assumes that everyone is motivated and
honest
– Some techniques may be biased
Classification and Diagnosis
In dx, we use either categories or dimensions
 Keys to a classification system
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– Must be clearly defined
– Groups or dimensions must exist (go together
regularly)
– Reliable—get same dx across observers
– Valid—provide us with useful info, not overlap with
other dx
– Clinical utility
Clinically Derived Systems
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From a consensus of clinicians about which sx usually go together
DSM-American
(ICD-10-other countries)
– Grew out of Kraepelin’s initial classification in 1883
– 1952-DSM-I had 2 categories for children-Adjustment reaction and
childhood schizophrenia
– Adultomorphism
– 1968—DSM-II—new section “Behavior Disorders of Child and
Adolescence”
– 1980—DSM-III—multiaxial
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Now DSM-IV-TR
5 axes
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I—Clinical disorders
II—Developmental disorders, personality disorders
III-General medical conditions
IV—Psychosocial stressors
V-Global assessment of functioning 0-100
Strengths and Weaknesses
of the DSM
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Reliability—test-retests is fair for dx such as ADHD, CD,
ODD--.51. to .64
Inter-rater is better for some than others—autism .85,
ODD .55
Strengths—common diagnostic language
– Wide acceptance and use
– Multiaxial
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Weaknesses—usually used for classification (not for
understanding or tx)
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Medical model
Reliability for kids and adolescents behind adults
Very complex
Labeling
Self-fulfilling prophecies
Empirically-based Taxonomies
Collect info in a standardized manner from
a large N of kids
 Analyze data through statistical means
 Explore associations between sx
 Develop scales based on these behavioral
items
 CBCL by Thomas Achenbach
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Therapeutic Interventions
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Settings for interventions
– Inpatient settings
– Residential tx facilities
– Group homes/therapeutic foster care homes
– Day hospitals
– Outpt settings
– School based mental health services
Involvement in Treatment
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Flisher et al 1997—at least 17% of kids and adolescents
with severe psychopathology never receive tx
Goodman et al 1997—compared with those who do not
receive services, those who do…
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Experienced higher levels of psychopathology
Showed lower levels of competence
More likely to have comorbid disorders
More likely to be non-Hispanic Caucasians
Less likely to be prepubertal girls
Tended to have parents who were
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More educated
More dissatisfied with their family functioning
Less involved in monitoring children’s behavior
More likely to have received tx themselves
Who drops out?
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High SES less likely to drop out
Attrition is lower when the whole family is
involved
Most parent factors are not significant
Congruence between parental expectations and
treatment recommendations is related to lower
attrition
More coercive referral sources are more likely to
drop out
Does therapy work?
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Consumer Reports surveys say pts are satisfied, but does it work?
Outcome studies—waitlist controls, no treatment controls, attentionplacebo control, standard tx/routine care control
Casey and Berman 1985—first large scale meta-analysis
– Tx outcome for those 12 and younger—64 studies—single ES for each
study
– Mean ES .71 -across studies the avg treated child functioned better
after tx than 76% of control kids
– Most tx (other than dynamic) were more effective than no tx
– Behavioral somewhat better than non-behavioral
– Worked whether play or no-play and parents and kids vs kids only
– Tx is somewhat more effective for specific problems than for social
adjustment problems
– Tx effective across observers
– Other meta-analyses have found very similar things
The Next Step in Efficacy
Goal now is to establish empirically
supported tx for specific problems
 Two categories
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– Well-established tx
– Probably efficacious tx (new tx that appears
effective from 1 or 2 high-quality studies)
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Problem—clinic vs. research tx—generally
clinic is less effective
Play Therapy
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One technique to discuss across tx
Problem: young kids are less
verbal, so play tx uses play to
concretize communications
2 primary perspectives
Dynamic—kids can’t do verbal free
association
– Now dynamic people view
play as a mode of expression
Client-Centered
– Axline—basic principles of CCT—
unconditional + regard, accurate
empathy, genuiness
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Non-directive
Not a great deal of support for
play therapy as a stand-alone
technique
 Typical play therapy room
contents:
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Tactile materials
Drawing materials
Dolls and dollhouses
Hand puppets
Nerf balls
Blocks
Communication facilitators
Psychodynamic Therapy
Very little support with children
 Historical importance
 Interpretation of unconscious conflicts
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Behavior Therapy
2 main types—child oriented and parent oriented
 Generally based on research principles
 Child-focused
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– Applied Behavior Analysis—focus on antecedents and
consequences of behavior
 Reinforcement, prompting, modeling, shaping, time out,
punish.
– Token economies
– Systematic desensitization
Parent-Oriented Behavior Therapy
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Behavioral Parent Training-Barkley
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Pay attention to and reward positive behavior
Ignore bad behavior
Allow natural consequences
Model appropriate behavior
Provide consistent and known consequences
Anticipate and plan for problem behavior
No idle threats
Limit the use of punishments
One 25 year follow up (Strain et al) showed
positive results
Evaluating Behavior Therapy
Achieves results in a short period of
time—less distress, lower cost
 Methods are clearly delineated; results
easily measured
 Works better with some problems than
others—rarely used for complex
personality disorders
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Cognitive-Behavioral Therapy
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Ellis—Rational Emotive Therapy
– Sustained emotional reactions are caused by internal sentences that people
repeat to themselves—irrational beliefs
– Eliminate self-defeatingness by rational examination
– Must decide together what to do
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Beck—Cognitive therapy
– Negative beliefs that people have about self, world and future cause disorders.
– Both behavioral and cognitive.
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Ellis—deductive—knows there are irrational beliefs
Beck—inductive—seeks negative beliefs
Social problem solving; skills training, assertion training—part of this
Efficacy
– Less research on Ellis’ model—what is there says that it does not work as well as
Beck’s approach.
Family Systems Therapy
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Family tx
– All members all the time
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Structural interventions
– Change family’s organizational patterns
Psychopharmacology
Medications are widely used, even if not widely studied in kids
 Zito et al 2000—studied kids aged 2-4 between at three sites/three payees
Stimulants 12.3, 8.9, 5.1 per 1000
Antidepressants—3.2, 1.6, .7
 Antidepressants—limited support, not studied until recently
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– Fairly equivocal results
– Only two are approved (Prozac and Zoloft)
– Suicide concern
Anxiolytics—limited evidence, limited research
Antipsychotics—older kids with later onset of schizophrenia, higher
intellectual functioning respond better
 Psychostimulants—about 75 % of kids with ADHD respond well. Help
attention and impulsivity but not social skills or academics
 Drawbacks to meds—side effects; message that med use sends
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Prevention
20% of kids have disorders, even 10%
would be a huge need if more than 5% of
those in need got help
 Primary—entire community
 Secondary-children at risk
 Tertiary—prevent recurrence
 DARE
 Head Start
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Attention Deficit
Hyperactivity Disorder
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Symptoms
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– Inattention
– Before age 7 (but some
studies find little diff
between before or after 7)
– 6 mos duration (may be
too brief for young kids)
– 2 or more settings
– Evidence of significant
impairment
 Losing things
 Disorganized
 Can’t follow through on
steps
 Easily distracted
– Hyperactivity
 Talkative
 Driven by a motor
 Run in situations when it
is inappropriate
Keys
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3 types—primarily
inattentive, primarily
hyperactive, combined
Prevalence
Lots of controversy, lots of research
 In 2009—25 % of articles in Journal of Abnormal Child
Psychology were about ADHD
 Some controversy about whether it is all one disorder or
two
 Prevalence—3-5 % of kids (2-10%)
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50-60% when clinical or special education samples are used
Kids tend to be referred for help between ages 7-9
50-80% will continue to have problems into adulthood
Boys outnumber girls by 2:1, some reports as high as 9:1
Gender Differences
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Compared with boys with ADHD, girls with ADHD tend to
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have lower intellectual functioning
have lower levels of hyperactivity
fewer comorbid externalizing problems
inattentive types
No gender differences in
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fine motor skills
social functioning
academic performance
impulsivity
family relationship variables like parental depression or parental
education
Inattention
May be able to pay attention in some
situations
 Not deficient in selective attention
 Instead a basic deficit in the ability to
sustain attention—CPT, reaction time
 Deficit is context-dependent and taskdependent
 All of this suggests, perhaps, a
motivational deficit
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Hyperactivity and Impulsivity
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Hyperactivity
– Far less robust dimension than inattention
– Some evidence that they are more active on a 24 hr basis
(including sleep)
– Greater restlessness
– Differences most marked in younger kids—decrease. with age
– Situation dependent
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Impulsivity—cognitive vs. behavioral impulsivity
– Act before they think
– Complex tasks—accept 1st solution that comes to mind
– Make very rapid responses, as well as irrelevant and
inappropriate ones
– Do not lack search strategies, but they are deficient
IQ and Academic Achievement
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7-15 pts below avg—not clear if IQ is low or poor testtaking skills
Do poorly in school
– Repeat more grades, lower marks on standardized measures of
reading, spelling, vocabulary, and math
– Academic performance decreases with time
– 40% receive some form of special education by adolescence
– Cognitive etiology—core cognitive problems prevent
development of problem-solving
– Motivational factors—school failures lower self-esteem and
undermine desire to achieve as child grows older
ADHD and Memory
Intact as long as the list of stimuli is
relatively short
 Deteriorates as # of stimuli to be
remembered increases
 Appears that, instead of increasing in
effort as task becomes more difficult,
actually expend less effort and use less
efficient memory strategies
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Higher Order Processes
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Adequate on simple, but performance decreases as task
complexity increases
Word knowledge—2 vs. 5 choices
When asked to scan an array, they skip around and
focus on novel or striking stimuli instead of processing all
relevant info
Performance increases with interest in task
When told about more effective strategies, don’t always
use them
Poor metacognition
Response to Reinforcement
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Performance will increase if every correct response is
reinforced
Withdrawal of expected rewards can interfere with
performance, even on simple tasks
Performance deteriorates when reward is given after
every 2nd correct response or at regular intervals
Exceptionally strong need for immediate gratification
Tend to invest more energy and interest in obtaining the
reward than solving the problem (not task-oriented)
Other Characteristics
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Accident proneness—1/2 described this
way
– 15% have had 4 or more serious injuries
– 3x more likely to have accidental poisoning
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Distorted self-perceptions—positive
illusory bias
Comorbidity and
Differential Diagnosis
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Comorbidity—rule rather than exception for ADHD
– Between 42 & 93% for ext, 13-51% for internalizing
Conduct disorder—20-50%
– CD alone—more antisocial parents, more family hostility
– ADHD alone—more frequently off-task in school and play
– Kids with both have worst features of both
LD
– 10-92%--Loose defs of LD. Rigorous defs -17-35 %
– Inattention leads to learning probs and vice versa
– Less task persistence in ADHD kids
Speech or language—30-60% have impairments
– Use fewer pronouns and conjunctions
– Also more formal speech problems
Differential diagnosis—bipolar, PTSD, FAS, lead poisoning
Course of the Disorder
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Preschool
– 6 mos required of DSM may be too short, at least 1 yr is more
predictive of future problems
– Preschoolers –restless, driven by a motor, impulsive, incr. risk
for accidents and poisoning, moody, demanding of attn., defiant,
noncompliant
– 40% of 4 yo have problems with attention severe enough to be
noted by teachers or parents but, for most of these kids,
problems are gone in 6 mos
– Of 4 yo. with ADHD, only 48% will still have dx in middle
childhood or adolescence
– Those who develop it earlier have greater problems with
cognitive functions, worse family functioning, increased
comorbidity, increased likelihood of it lasting to adolescence
Course of the Disorder
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Middle childhood
– 50% experience peer rejection
– ADHD who aren’t comorbid are in the minority
– ½ will have individual or family tx
– 1/3 will receive some special education
services
– Parents note failure to accept responsibility,
having to supervise self-help activities such as
dressing and bathing, temper tantrums,
immaturity
Course of the Disorder
50-80% continue to show sx of ADHD
 25% engage in antisocial behavior such as
stealing or fire setting
 50-70% repeat grades
 8x as likely to be expelled or drop out of
school
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Course of the Disorder
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Adulthood
– Longitudinal studies show continuing
problems with ADHD, antisocial PD, substance
abuse (31% vs 3% of controls)
– More car accidents/tickets
– Less job stability
– Academic achievement suffers
– No direct connection with criminality—only if
comorbid with CD
Etiology
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No one theory that everyone accepts
Family-genetic risk factors
– Twin studies—70-80%
– Between 25-30% of first degree relatives of kids with ADHD also meet
criteria
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Neurobiological factors—abnormalities in frontal-striatal region
– Limitations in self-control and behavioral inhibitions (Barkley)
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Family factors—
– Negative controlling mother-child interactions begin when child is as
young as 2 or 3
– Mothers report incr. stress, incr. social isolation, incr. distress
– Interactions improve on both sides when child is given Ritalin or when
Valium is given to mother
– Hoover & Milich—gave kids placebo—mothers told it was sugar reported
increased hyperactivity, were more critical
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Things that don’t cause ADHD—diet, food additives, sugar
Treatment of ADHD
No known cure
 Medication—1937 math pills
– Effectiveness rates range from 50-95% (about 70%)
– 20-30% show no effects or adverse effects
– When treated—less impulsive, more planful, fewer task-irrelevant
behaviors, more goal-directed, more coordinated—makes beh more
appropriate
– Academic achievement and social skills—not improved—never learned
in the first place
– Can create kids who credit success to medication and failure to selves
– Other problems—can be addictive, can make kids jumpy or zombie-like,
bland mood
 Overuse? About 3% of all school age kids
– 90% of scripts for methylphenidate are in US—at least 5x higher than
other places
– Girls and adolescents are less likely to receive stimulants
– 90% of visits to physician with complaints of hyperactivity result in
script
 At least 50% of kids dx’d with ADHD are not treated in a way consistent
with recommendations of the American Academy of Child and Adolescent
Psychiatry
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Treatment of ADHD
Behavioral Parent Training
 Behavioral Interventions in the classroom
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– Both are empirically supported
– Basically involve education into observing behavior, reinforcing + behavior, token
economies, appropriate discipline, empowering parents to work with schools,
time out
– Works best for kids 2-11
Intensive summer programs
Combination of behavioral methods and medications works best
 Other interventions
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Cognitive-behavioral interventions—may help with problem solving
Social skills training
Diet—not effective for majority of kids
Funny glasses
Sensory integration training
Biofeedback?