Children and Adolescent ADHD
www.pspbc.ca
Child
& Adolescent
Attention Deficit
Hyper Activity
Disorder
(ADHD)
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Fast Facts:
Child & Adolescent ADHD
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Receives much media attention and controversy
Neuro-developmental psychiatric disorder
Impairs social, academic, family, and occupational functioning
In Canada: 5 – 10 % in youth; 3 – 5 % in adults
Associated with serious mental disorders:
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Learning Disability
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Conduct Disorder
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Oppositional Defiant Disorder
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Anxiety Disorders
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Major Depressive Disorder
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Disruptive Mood Dysregulation Disorder
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Intermittent Explosive Disorder
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Fast Facts:
Child & Adolescent ADHD
 Greater risk for:
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Poorer academic achievement
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Fewer friends
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Lower self-esteem
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Teen pregnancies
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Substance misuse/abuse
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Interpersonal difficulties
 More prone to:
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Physical injury
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Accidental poisoning
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Traffic accidents
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Fast Facts:
Child & Adolescent ADHD
 More likely to:
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Score lower on achievement tests
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Repeat grades
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Suffer suspensions
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Have problems with school
 Early treatment & effective therapies can help:
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Medications
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Psycho-education, and/or
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Behavioral Intervention
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Typical School Report Card Notes
 Stan [Kutcher] is disruptive in class, he is always talking and has
great difficulty sitting still
 Stanley cannot settle down to do desk work – he is always fidgeting
 Stanley is not getting his homework done, he forgets to take his work
home or to bring his homework to school
 Stanley’s grades do not reflect what he is capable of doing
 Stanley is so disorganized that he will never be successful at
anything
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ADHD Screening Question
3. Overall, do you have problems concentrating, keeping your mind
on things or do you forget things easily (to the point of others
noticing and commenting)?
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If YES – consider ADHD
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Apply the SNAP-IV 18 item
scale
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Proceed to the Identification,
Diagnosis and Treatment of
the Child and Adolescent
ADHD Module
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ADHD Screening Tool – Parent Version
Does your teenager usually not finish things that he or she starts?
Is your teenager not able to pay attention to things for as long as other
teenagers?
Does your teenager fidget or move around much of the time, even when he/she
knows she should not?
Is your teenager impulsive or does he/she act without thinking much of the
time?
Is your teenager’s behaviour causing him/her problems at home and at school?
Have these difficulties been there for a long time (six months or longer)?
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ADHD Screening Tool – Youth Version
Are you able to finish most things that you start within the time others expect?
Do you have trouble paying attention to things that are not that interesting to
you?
Do you fidget or feel you have to move around much of the time?
Do you often do things without thinking?
Are you having problems at home or school related to your behaviour or because
of trouble paying attention?
Have these difficulties been there for a long time (six months or longer)?
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Key Steps
for Treatment of ADHD
to Children & Adolescents
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Identification of child/youth at risk for ADHD
Methods for screening & diagnosis
Treatment template
Suicide assessment (for adolescents only)
Safety and contingency planning
Referral flags
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Step 1:
Identification of Risk for ADHD
Well established and
significant risk effect
Less well established
risk effect
1. A previous diagnosis of ADHD
1. Exposure to severe
environmental factors (i.e., lead
contamination, prenatal exposure of
alcohol and cigarette, birth trauma,
low birth weight, head injuries).
2. Psychosocial adversity such as
maternal depression, paternal
criminality, chaotic home
environment, and poverty
3. Substance misuse/abuse (early
onset of use including cigarettes
and alcohol)
4. Head injury (concussion)
2. Family history of ADHD
3. Family history of mental
disorders (affective, anxiety,
tics or conduct disorder)
4. Psychiatric Disorder:
Oppositional Defiant Disorder,
Conduct Disorder or a
Learning Disorder
Possible “group”
identifiers
(these are not causal for
ADHD but may identify
factors related
to adolescent onset ADHD)
1. School failure or learning
difficulties
2. Socially isolated from peers
or behavioural problems at
home and at school
(including gang activity &
legal problems) – accident
prone.
3. Bullying (victim and/or
perpetrator)
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If Child is High Risk…
 Check for patterns of:
› Declining grades
› Frequent lates/absences
› Discipline concerns
› Homework not completed
› Concentration problems
› Over-activity or inattentiveness
 Confidentiality & informed consent
› Speak with both child and parents
› Easier for child to access care
› Easier for parents to know what to expect
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Step 2:
Useful Methods for Screening &
Diagnosis of ADHD in the Clinical Setting
 Part of general health visits
› Screen at regular visits
› Screen teens during visits for contraception/sexual health issues
› Presentation of ADHD symptoms may change over time
 Younger children are more impulsive and hyperactive
 Adolescents are less hyper, but have inner restlessness,
impulsivity and inattention
 Co-morbidity of ADHD
› Anxiety, Opposition Defiant Disorder, Disruptive Mood Dysregulation
Disorder, Conduct Disorder, and Learning Disorder
› Consider possibility of one or more of these disorders
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Screening & Diagnosis of ADHD
Approx. 65% of children with ADHD still
meet diagnostic criteria during adolescence
 Child/Adolescent may show:
› Inattention
› Distractibility
› Impulsivity
› Hyperactivity
 Requires health provider
intervention
› Differentiate between normal responses to circumstances or
developmental changes in normal children
› Use the “Distress versus Disorder” model
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Screening & Diagnosis of ADHD
3 Sub-categories
1.
Predominantly Inattentive
› 20 – 30% of children and adolescents with ADHD
› Daydreaming, distractibility and difficulty focusing on a single task for a
prolonged period
2.
Predominantly Hyperactive-Impulsive
› 5 – 10% of children and adolescents with ADHD
› Manifesting as a situational inappropriate and excessive motor activity such
as fidgeting, excessive talking, impulsive actions and restlessness
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Combined Inattentive/Hyperactive
› 60 – 70% of children and adolescents with ADHD
› Manifesting as a combination of the above two
subtypes
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Screening & Diagnosis of ADHD
 No biological diagnostic tests for ADHD
› Clinical assessments of:
 Signs
 Symptoms
 Clinical History
› Carry out evaluations over more than one visit
 2 to 3 visits are often needed
 No hurry for a diagnosis; Take Your Time
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Clinical Findings for ADHD
Early Childhood 3 – 5 years of age
 Difficulty attending
› Reading a storybook with parent, or coloring/drawing
 “Squirmy”
 Difficulties “settling”
 Very active, always on the go
› Bumping into things/getting hurt
 Parents refer to child as:
› “Not listening”
› “Zippy”
› “Always running around”
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Clinical Findings for ADHD
Middle Childhood 6-12 years of age
 Child may not persist long with most tasks
› Particularly what they do not want to do
 Parents report child:
› Does not pay attention or listen
› Is very forgetful or disorganized
 Described as:
› “Overactive”, “always on the go”
& “cannot sit still”,
› Acting out of turn
› Blurting out in class
› More evident in situations where attention is expected
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Clinical Findings for ADHD
Middle Childhood 6-12 years of age
 School reports, “…not living up to academic
potential”
 Difficulty with peers
 Impulsivity & intrusiveness
An active child does not mean ADHD
Girls with ADHD may demonstrate
inattentiveness, not hyperactive symptoms
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Clinical Findings for ADHD
Adolescence 13 – 19 years of age
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Easily distracted from tasks
Feelings of inner restlessness
Stopping short on tasks
Forgetful; fail to complete tasks
Fidgety
Difficulty with relationships
› Many “breakups”
 Impaired temper control
 Impulsive decision making
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Clinical Findings for ADHD
Adolescence 13 – 19 years of age
 Engage in “risky” behavior
› At higher risk for traffic accidents
 Considered “lacking maturity” for their age
 Without treatment, exhibit signs of demoralization
› Due to negative comments
› “Nagging” from parents, teachers, adults and peers
› Do not confuse demoralization with depression
 May get involved in drug use and criminal behavior
 School drop outs, especially with unidentified learning
disability
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Screening & Diagnosis of ADHD
 Not likely ADHD if:
› Symptoms only in one setting
› Not functionally impairing
 ADHD type symptoms may be
› Post Traumatic Stress Disorder (PTSD)
› Consider PTSD as a diagnostic possibility in youth who exhibit
ADHD symptoms for whom a significant traumatic event has
recently occurred. Remember: ADHD prior to age 12.
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Youth ADHD Screening Q’s
Inquire about substance
misuse/abuse
- Including marijuana Youth with ADHD may be more likely
to use a variety of substances
Specialist consultation
for substance abuse & ADHD
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