Stephen P. Amos PhD
Associate Professor
Department of Pediatrics
University of Kansas School of Medicine–Wichita
ADD vs. ADHD
 What’s the difference?
 The short answer to this question is:
What’s New?
 Guidelines for treatment
and new tools for dealing
with ADHD
 Behavior management
techniques
What’s New?
 Adult treatment
alternatives
What’s New?
 Knowledge of medication
 New books and websites
What’s Not New?
 ADHD is real
 ADHD doesn’t go away
 Other problems are associated with ADHD
 It’s long hard work to deal with
 There are very effective treatments
Assessment
 The essential questions:
1. Are the behaviors in question excessive, long-term,
and pervasive?
2. Are they a continuous problem, not just a response to a
specific situation?
3. Do the behaviors occur in every setting?
4. Have the behaviors been present prior to age 7, and
continuous for at least 6 months?
The Essential Deficit
 Developmental delay in inhibition
 Not being able to delay gratification
 Impaired self regulation
The Essential Deficit (cont.)
 Deficits in executive function
 Five components
1.

Working memory
Holding facts in mind while manipulating information;
accessing facts stored in long term memory
The Essential Deficit (cont.)
 Deficits in executive function
 Five components (cont.)
2.

3.

4.

5.

Activation, arousal, and effort
Getting started, paying attention, finishing work
Emotional control
Ability to tolerate frustration, thinking before acting or
speaking
Internalizing language
Using ‘self talk’ to control one’s behavior, and direct future
actions
Complex problem solving
Taking an issue apart, analyzing the pieces, reconstituting and
organizing it into new ideas
KUSM–W Pediatric Residency
ADHD Checklist
Other Key Parts of Assessment
 Behavior rating scales parent/teacher/other
 Clinical interview
 Verbal and written reports of school performance and
behavior
 Neuropsychological testing (CPT, TOVA, GDS, IVA)
 Medical evaluation; including hearing and vision
testing
 Screen for co-existing disorders such as:
 Oppositional defiant disorder
 Anxiety or mood disorders
Treatment Options
 Medication management
1. Careful selection of medication based on patient
history and risk profile
2. Clinical trials to achieve optimal results with minimal
dosage
3. Careful monitoring of medication effects and side
effects
4. Vigilance for signs of substance abuse
Treatment Options (cont.)
 Cognitive behavioral treatment
1. See www.additudemag.com
2. Most programs will involve teaching both child and
parenting skills
a.
b.
c.
Developing attention skills (see: www.addwarehouse.com or
www.childswork.com)
Building self esteem (see: The Survival Guide for Kids With
ADD or ADHD by John Taylor; or Learning to Slow Down
and Pay Attention by Kathleen Nadeau and Ellen Dixon)
Anger and frustration management using the STOP
program
Treatment Options (cont.)
 Cognitive behavioral treatment
2. Most programs will involve teaching both child, and
parenting skills
Treatment Options (cont.)
 Cognitive behavioral treatment
2. Most programs will involve teaching both child, and parenting
skills
Steps for parents:
d.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Understanding why children misbehave
Paying attention to the child
Increasing compliance and decreasing disruptiveness
When praise isn’t enough: Poker chips and points
Time out, assigning work, taking away privileges
Extending time out to other problems
Managing children in public places
Improving school performance
Handling future problems
One month and three month booster sessions (see: Your Defiant Child
by Russell Barkley and Christine Benton)
Treatment Options (cont.)
 Cognitive behavioral treatment
3. Alternative treatments
a.
b.
c.
d.
Emwave and Heartmath (How to help your child and
yourself)
Omega 3’s
Herbal treatments and red dye #2
Caffeine, etc.
4. Personality and ADHD, the role of psychological type
Treatment Options (cont.)
 Cognitive behavioral treatment
5. Some survival rules to consider
a.
Write everything down
Treatment Options (cont.)
 Cognitive behavioral treatment
5. Some survival rules to consider (cont.)
Put everything where it belongs right away
When you think of something that needs done do it, or write it down
Double check yourself several times a day
Let people help you, ask for help when you need it, and thank people
when they help you
Use things the way they were intended to be used
Never agree to anything without checking your calendar first, then see
rule “A”
Watch what your hands are doing so you will know where you put
things
Say no when you have to, which may be often
When all else fails, see rule “A”
b.
c.
d.
e.
f.
g.
h.
i.
j.
a.
Adapted from Mark Romereim’s Survival Rules for ADHD