According to the Centers for Disease Control and Prevention (CDC) most recent survey data in 2011, there were 8.8% of children ages 4 to 17 diagnosed with ADHD, which was an increase from 2007, with 7.2% of children diagnosed with ADHD. Males are more frequently diagnosed with ADHD in both children and adults compared to females: roughly at a 2:1 ratio for children and 1.6:1 for adults (DSM-5, 2013).
The organization, Children and Adults with Attention Deficit Hyperactivity Disorder (CHADD), in conjunction with the CDC, reported on coexisting conditions diagnosed along with ADHD. Approximately 40% of individuals diagnosed with ADHD are also diagnosed with Oppositional Defiant Disorder (ODD), 14% of children meet criteria depression, 30% for anxiety, 50% for a learning disorder, and 60% to 80% of individuals diagnosed with Tourette Syndrome also meet criteria for ADHD. Given the high occurrence of co-existing conditions, it is clear that both comprehensive evaluations and multiple component treatment programs are the foundation for intervention.
Thaper, Cooper, Jefferies, and Stergiakouli (2012) identified common risk factors for ADHD. It should be noted that no one single factor is responsible for ADHD presentation; it is a combination of genetic and environmental interplay that affects symptomology. Higher ADHD rates are found with parents or siblings diagnosed with ADHD, mothers who smoke, use alcohol, drugs, or have elevated stress/anxiety during pregnancy. Infants who are delivered prematurely and/or have a low birth weight, have been exposed to toxins (pesticides, lead, PCBs), and have experienced extreme deprivation are at a greater risk. Although low parental education, social class, poverty, bullying, negative parenting, and family discord are associated with ADHD, there has not been a causal link identified for such factors. The authors also noted that sugar, artificial food colorings, zinc, iron, magnesium, or omega-3 fatty acids have not be implicated in ADHD symptoms. However, it was indicated that this does not mean that dietary changes may not help to modify ADHD symptoms. There are not enough rigorous, scientific studies at this point to suggest that dietary changes may ameliorate ADHD symptoms.
Prognosis for untreated ADHD related symptoms is mixed. Beiderman and colleagues (2012) found that males, participating in a 16-year follow-up study, experienced psychosocial, educational, and neurophysiological functioning impartments more frequently when compared to their non-ADHD diagnosed counterparts. For females participating in an 11-year follow-up study, Bierdman and colleagues (2010) found increased risks of antisocial disorders, depression, and anxiety as compared to their non-ADHD diagnosed counterparts. Given this information, the rule of thumb is earlier the better when it comes to treatment, but there is never a point where interventions should not be attempted. Additionally, it also suggests that individuals diagnosed with ADHD may need different types of interventions throughout the lifespan.
When interventions are attempted initially, a medication-based intervention appears to be first. The CDC indicated that of those diagnosed with ADHD, 69% in 2011 were receiving pharmacological based treatments. It is not clear if behavioral treatments were attempted first, however, due to potential negative side effects of medication treatment, a behavior-based treatment should be the first line of intervention as this is less physiological intrusive, although it is often more effortful and time-consuming at least initially. However, by learning skills in a supportive environment, the child can discover what works for them in helping them succeed in school and home.
Next time, we’ll examine a particular set of skills that tend to be a core deficit for individuals diagnosed with ADHD and some thoughts about building those skills.
ADHD Series by Dr. Glenn Sloman
Continue reading using the links below:
- What Is ADHD? Part 1
- ADHD Symptoms Part 2
- Who is Diagnosed with ADHD? Part 3
- Executive Functioning Part 4
- Another Way of Looking at Impulsivity Part 5
- Promoting Success with ADHD Part 6
References
Attention-Deficit / Hyperactivity Disorder (ADHD). (2017, July 18). Retrieved October 02, 2017, from https://www.cdc.gov/ncbddd/adhd
Biederman, J. et al. (April 2010). Adult Psychiatric Outcomes of Girls with Attention Deficit Hyperactivity Disorder: 11-Year Follow-Up in a Longitudinal Case-Control Study. American Journal of Psychiatry 167(4):409-417.
Biederman, J. at al. (July 2012). Adult outcome of attention-deficit/hyperactivity disorder: a controlled 16-year follow-up study. Journal of Clinical Psychiatry 73(7):941-50.
CHADD – The National Resource on ADHD. (n.d.). General Prevalence of ADHD | CHADD. Retrieved October 02, 2017, from http://www.chadd.org/understanding-adhd/about-adhd
Diagnostic and statistical manual of mental disorders DSM-5. (2013). Arlington, VA: American Psychiatric Association.
Najdowski, A. C. (2017). Flexible and focused: Teaching executive functioning skills to individuals with autism and attention disorders. San Diego, CA: Academic Press.
Thapar A, Cooper M, Jefferies R, et al. What causes attention deficit hyperactivity disorder? Archives of Disease in Childhood 2012; 97:260-265.
The Understood Team. (n.d.). 3 Areas of Executive Function. Retrieved October 02, 2017, from https://www.understood.org/en/learning-attention-issues/child-learning-disabilities/executive-functioning-issues/3-areas-of-executive-function
About The Author
Glenn M. Sloman, Ph.D., BCBA-D, NSCP is a Licensed Psychologist in New Jersey and Pennsylvania and a Board Certified Behavior Analyst at the Doctoral level. Dr. Sloman is also a Nationally Certified School Psychologist and a Certified School Psychologist in New Jersey. He earned his undergraduate degrees with honors in Psychology and Anthropology at the University of Florida. Dr. Sloman attained his Master’s in Education and Ph.D. in School Psychology at the University of Florida where he specialized in Behavior Analysis. He previously served as a program coordinator for Douglass Developmental Disabilities Center Outreach Program and supervisor of home staff in programming for individuals with an Autism Spectrum Disorder (ASD). Dr. Sloman has worked in New Jersey school districts as a case manager and school psychologist on a child study team developing and implementing individualized education programs (IEPs) and behavior improvement plans (BIPs), providing individual and group psychotherapy, social skills training, and staff and parent consultation.
Dr. Sloman is skilled in conducting psychological and psychoeducational evaluations, and functional behavior assessments (FBAs). He has experience providing outpatient psychotherapy to children, adolescents, and adults from ethnically and economically diverse backgrounds, and providing parent support and training.
Dr. Sloman has extensive experience in the treatment of children through adults who present with symptoms of anxiety, depression, ADHD, ASD, learning disabilities, oppositional defiant disorder, obsessive compulsive disorder, mood disorders, and social skills deficits. He also has expertise assisting individuals transitioning from high school to college life.
Dr. Sloman’s professional interests include Acceptance and Commitment Therapy (ACT) and applying Behavior Analysis in treatment and consultation. Dr. Sloman’s goals for his clients are to increase their psychological flexibility in pursuit of doing what matters to them and creating meaningful behavior change. He is a member of the American Psychological Association, the New Jersey Psychological Association, and the Association for Contextual Behavioral Science.
