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How To Improve Your Childs Behavior

How to Improve Your Child's Behavior The definitive program on how to teach Your Difficult Child better behavior and to help you become a more effective parent. You Will be Able to End the defiance, battles and vicious fighting in your home. Fix your relationship with your child. Bring peace and happiness to your home. Enjoy a more fulfilling relationship with your child. Have your child respect you. Regain control over your child, you life and your home. Put an to all the arguing, fighting, and talking back. Have your child obey you without complaining. Get rid of all the hostility. Gain absolute confidence as a parent and know how to handle any situation.

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Attention Deficit Hyperactivity Disorder

The validity of ADHD as a clinical diagnosis has long excited debate and controversy in both lay and scientific circles. An expert panel convened and sponsored by the National Institutes of Health recently reviewed and documented extensively within a Consensus Statement the validity of ADHD as a clinical disorder, its public health importance for children and families, and the effectiveness of its treatments (NIH, 2000). Among their many conclusions, the conference panelists concurred that ADHD meets or exceeds the standards for validity established by most other disorders defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Still unclear, however, is whether the disorder represents a behavioral syndrome that is qualitatively and etiologically distinct from the range of ADHD-like symptoms present in children within the general population. Attention deficit hyperactivity disorder comprises the symptomatic triad of inatten-tiveness,...

Attention DeficitHyperactivity Disorder ADHD

Taking Charge of ADHD The Complete, Authoritative Guide for Parents. New York Guilford. Hollowell, E. M., & Ratey, J. J. (1995). Driven to Distraction Recognizing and Coping With Attention Deficit Disorder from Childhood Through Adulthood. New York Simon & Schuster. Ingersoll, B. (1995). Distant Drums, Different Drummers A Guide for Young People with ADHD. Buffalo, NY Cape Publishing. Kelly, K., & Ramundo, P. (1996). You Mean I'm Not Lazy, Stupid or Crazy A Self-Help Book for Adults with Attention Deficit Disorder. New York Fireside. Murphy, K. R., & Levert, S. (1995). Out of the Fog Treatment Options and Coping Strategies for Adult Attention Deficit Disorder. New York Hyperion.

Patient Encounter Part 2 Medical History Physical Exam and ADHD Evaluation

AD's baseline physical examination is unremarkable. Family history is negative for cardiovascular disease, and there is no documented history of ADHD in the family. Table 42-4 30-Day Cost0 of Selected ADHD Medication Regimens Clonidine and guanfacine are central a2-adrenergic agonists that inhibit the release of norepinephrine presynaptically. Both these agents are less effective than stimulants in treating symptoms of ADHD but typically are used as adjuncts to stimulants to con

Learning Difficulties Dyslexia Attention Deficit Disorder and Prosopagnosia

Leonardo also appears to have a mixed form of attention deficit disorder that contains both daydreaming and restlessness as well as the ability to hyperfocus, which is the capacity to concentrate for an extended period of time. While Leonardo's restlessness often prevented him from finishing long-term projects, it helped him create short-term works such as drawings. By the end of his life, Leonardo made over four thousand drawings, a number four times greater than any other individual of his time. Leonardo employed his ability to hyperfocus during the long hours he is recorded as working on his art. He used his propensity to daydream to create inventions such as his machines. When assembled over 500 years later from Leonardo's original drawings, these machines worked perfectly. Dyslexia has also affected the career choices of contemporary artists. Greystone Elizabeth Abbott (American, b. 1959) became a ceramic artist in response to an academic impediment in college. Yet the dyslexia...

Playfulness and ADHD

Another relationship of the play urges of the brain to psychiatric issues has been in attempts to conceptualize at least some of the impulsive and hyperactive symptoms of ADHD as unsatisfied play urges that need to be expressed, as is evident in animal models (Panksepp, 1998b). The utility of play therapy in an animal model of ADHD has been demonstrated (Panksepp et al., 2003). Considering that drugs used to treat ADHD are uniformly ones that reduce play urges, and which may sensitize reward and drug-seeking systems of the brain (Nocjar and Panksepp, 2002 Panksepp et al., 2002a), the issue of what natural play does for the developing brain mind becomes an urgent neuropsychiatric question. Preliminary evidence suggests that in addition to well-accepted, but poorly demonstrated, psychological developmental effects, play may also promote neurotrophin gene expression that may have beneficial long-term effects for the brain (Gordon et al., 2003). These issues should coax us to consider...

Organization of Services

In general, pediatricians, general practitioners, and adult psychiatrists are the primary care providers for children and adolescents with psychiatric issues. However, referrals of children and adolescents for psychiatric treatment tend to be limited as a result of stigma attached to psychiatric illness and poor training at the graduate level of education. Families are more inclined to seek help for a child's academic difficulties and are more willing to pursue treatment options, including medication use, in the context of academic progress. In recent years, especially in metropolitan cities like Bangalore, practitioners have been receiving increasing referrals regarding learning disabilities, attention-deficit hyperactivity disorder,

Therapeutic Interventions

Administer to the client psychological instruments designed to objectively assess ADD and substance abuse (e.g., Conners' Adult ADHD Rating Scales CAARS ) give the client feedback regarding the results of the assessment. 24. In a family session, teach the family members the connection between ADD and addiction, going over what each family member can do to assist the client in recovery (e.g., go to Alanon meetings, reinforce positive coping skills, keep expectations realistic, go to ADHD support group). 25. Provide the family members with information about ADHD (e.g., You Mean I'm Not Lazy, Stupid, or Crazy by Kelly and Ramundo).

Is the Disorder Familial

An obvious example of the matching fallacy is as follows. Numerous studies find that attention deficit hyperactivity disorder (ADHD) interferes with school achievement (Faraone et al., 1993). Thus, matching controls to ADHD subjects on school achievement would create an unusually high functioning ADHD sample or an unusually low functioning control sample. It may be difficult to draw meaningful inferences from such samples. Instead of matching, we use statistical methods to examine and control for the effects of potentially confounding variables.

Issues in Using Self Report Data

However, has demonstrated that the accuracy of such self-report data in medical and mental health settings is questionable. For example, there is low agreement between patients and informants in the assessment of personality disorders (Riso et al. 1994) and adult attention-deficit hyperactivity disorder (Zucker et al. 2002). In addiction psychiatry, patient self-report of illicit drug use can be highly inaccurate, depending on the patient population (i.e., arrestees vs. patients in treatment), the context in which the data are collected, the type of drug used, the method of survey, and the recency of use (Harrison and Hughes 1997 McNagny and Parker 1992 Weiss et al. 1998). In the assessment of major life stressors, there is a poor rate of agreement between subjects and informants regarding whether a particular life event has occurred (Schless and Mendels 1978). Even the self-report of one's stature has been shown not to be accurate, at least for men (Giles and Hutchinson 1991).

Monoamine Reuptake Inhibitors

Reboxetine was approved for use as an antidepressant in much of western Europe, South America, and Mexico in 1998. Reboxetine is the only truly selective NRI being marketed as an antidepressant, although U.S. Food and Drug Administration (FDA) approval has recently been granted to atomoxetine, a selective NRI (Bymaster et al., 2002) approved for the treatment of attention deficit disorder. Reboxetine potently inhibits the reuptake of NE without having significant effects on the reuptake of 5-HT or DA. It does not inhibit MAO, nor does it bind to 5-HT1a or 5-HT2a, DA1 or DA2, a-or p-adrenergic, muscarinic cholinergic, gamma-aminobutyric acid (GABA), benzodi-azepine, or histamine H1 receptors. Reboxetine has primarily been studied in European trials involving about 665 nonelderly and 56 elderly (age > 65 years) depressed patients (Burrows et al., 1998). It is administered twice per day at doses ranging from 4 to 12 mg day. The European data show that reboxetine is more effective than...

Family losses other than death

Pete was a 13-year-old boy who had been mandated for counselling by the county's children protective services and juvenile court. He had had four foster home placements over the last six years, failed three grades, had been diagnosed with ADHD, and had severe anger problems. The initial assessment (plus past records) indicated multiple issues of loss over his entire lifetime. He was the oldest of three children and had taken on the role of protector for his alcoholic mother and two sisters when he was 7. In addition to mom's alcohol abuse, she had had multiple abusive relationships. Pete prided himself on beating up one of mom's boyfriends with a wooden board when he was 11. The pattern over time showed that mom had multiple attempts to reclaim her children, but was not capable of any consistent stability. Pete's foster home placements were never successful. He always found a way to sabotage himself and develop a negative relationship with any adult or system that offered support. His...

Clinical presentation and diagnosis

O ADHD is rarely encountered without comorbid conditions, and often is underdiagnosed. Between 40 and 75 of patients with ADHD will have one or more comorbidities (e.g., learning disabilities, oppositional defiant, conduct, anxiety, or depressive disorders).10 It is important to identify other coexisting conditions in patients with ADHD to select initial and modify ongoing treatment. The most useful diagnostic criteria for ADHD is the Diagnostic and Statistical Manual of Mental Health Disorders, 4th edition, Text Revision (DSM-IV-TR) (Table 42-1). The DSM-IV-TR defines three subtypes of ADHD (a) predominately inattentive, (b) predominantly hyperactive impulsive, and (c) combined, in which both inattentive and hyperactive symptoms are evident.11 Neuroimaging, electroencephalograms, and continuous performance examinations are investigational and not used clinically for diagnosis. It is recommended that parents and teachers complete a standardized rating scale based on the DSM-IV-TR...

Pharmacoeconomic and Treatment Adherence Considerations

Proper ADHD treatment is a substantial financial burden. Annual health care costs of patients with ADHD are more than double those of patients without ADHD ( 1,343 versus 503, respectively). The financial burden of ADHD can be attributed to the direct cost of pharmacotherapy, office visits, diagnostic measurements, therapy monitoring, and indirect costs (e.g., lost work time and productivity). When selecting a treatment for an ADHD patient, the cost burden to the patient's family should be considered. Immediate-release stimulants may be more cost-effective in many patients compared with longer-acting stimulant formulations (Table 42-4), but in certain circumstances, longer-acting stimulant formulations may provide a greater benefit owing to increased adherence to the medication and prolonged control of symptoms of ADHD. Some nonstimulant ADHD medications (e.g., bupropion, TCAs, and a2-ad-renergic agonists) appear to be less costly than many stimulant formulations however, these agents...

Legal and Administrative Definitions

Thus, an individual with a diagnosis of depression or attention-deficit hyperactivity disorder may be eligible for accommodations under the definition of disability in the ADA. The same individual may not qualify as disabled according to the definition applied by the Social Security Administration in determining eligibility for Social Security disability income or by a private insurer in determining eligibility for benefits. The applicable definitions of disability in disability programs and the ADA are reviewed here briefly.

Diagnosis and Disability

Individual (Bonnie 1997 Gold and Shuman 2009). In disability evaluations, the ability to assess and explain how symptoms associated with a diagnosis affect a specific set of work skills is often more important than a diagnostic label and more relevant to the parties involved. An individual with attention-deficit hyperactivity disorder may function without any significant impairment in a job that involves completion of a task at his or her own pace by no particular deadline or may be totally disabled in a job that requires long periods of sustained attention to detail or the ability to multitask under time pressures.

Behavior Genetics Today

Tiousness and public sensitivity to the issue. Behavior geneticists such as Robert Plomin at Pennsylvania State University and Joel Gelernter at Yale University argue that the field has been misrepresented. They point out that many human behavioral genes, or at least chromosomal or molecular markers thought to be associated with specific genes, have been correlated with specific behavioral types such as Tourette's syndrome (leading to uncontrollable movements and speaking), schizophrenia, manic depression, alcoholism, attention deficit hyperactivity disorder (ADHD), and homosexuality, to name just a few. These correlations suggest strongly that there might be a significant genetic component to these behaviors. Human behavior genetic researchers emphasize that they do not discount the role of environment, nor the additive effect of many genes impinging on any given behavior. In fact, they make a point of emphasizing that the outcome of any behavioral development in humans (or any other...

The Ncsr Adolescent Survey Design And Rationale

The CIDI was expanded for NCS-A to include new sections on child and adolescent disorders derived from the DIS. These include oppositional-defiant disorder, conduct disorder, attention deficit hyperactivity disorder, and separation anxiety. We also modified existing CIDI diagnostic sections that have different criteria for adolescents than adults. In addition, the risk factor battery was expanded to include a more detailed assessment of childhood adversity, while the interview questions on treatment for emotional disorders were revised to blend relevant questions from NCS-R with questions in another instrument designed for use with children and adolescents (Stiffman et al., 2000). Once all these modifications were complete, revisions in question wording were made to improve comprehension among adolescent respondents. This work made use of recently developed cognitive interviewing methods to gain insights into areas of confusion in the instrument and into ways that these confusions...

Medium Chain AcylCoA Dehydrogenase Deficiency

Most patients present between ages 3 and 15 months, rarely after 4 years. Phenotypical heterogeneity prevails, ranging from sudden infant death syndrome, to recurrent Reye's-like syndrome, to episodic nonketotic hypoglycemic coma. A common presentation is vomiting and lethargy, followed by fasting, associated with a prior viral respiratory or gastrointestinal infection. Presentation is usually to an emergency department as an acute toxic encephalopathy or coma, with hypoketotic hypoglycemia, hyperammonemia, and abnormal liver function tests. Ihe serum carnitine value is low, and urine acylcarnitines are increased, with a specific profile. Enzyme assay for MCAD activity can be done on cultured skin fibroblasts, muscle, liver, or blood lymphocytes. Ihe differential diagnosis includes other fatty acid oxidation disorders, exogenous toxic encephalopathies, and true Reye's syndrome. Specific management involves intravenous dextrose 10 percent, avoidance of fasting with frequent short...

Psychopharmacologic Interventions In The Schools

In the 1990s, there was an increase in the use of psychotropic agents to treat a variety of mental disorders in children (Jensen, 1998). As Jensen notes (1998), this rise in the use of psychotropic agents occurred despite the fact that many of these medications have not been adequately tested for safety and effectiveness in children. This portion of the chapter alerts the practitioner to ethical and legal issues associated with the use of medications to treat children with school learning or behavior problems. Discussion here is limited to the use of Ritalin (methylphenidate hydrochloride), a drug that has been approved by the Food and Drug Administration for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in children age 6 years and older (Physicians Desk Reference, 2001). Ritalin is widely prescribed for schoolchildren in the United States (Marshall, 2000), and it provides an excellent example of both the promise and potential pitfalls of drug therapy.

Neurotransmitter Abnormalities

Dopamine and Other Neurotransmitters. Dopaminergic dysfunction in OCD is suggested not only by the obsessive-compulsive symptoms in patients with basal ganglia disorders but also by the increase in obsessive-compulsive symptoms following high-dose stimulant administration (Frye and Arnold, 1981) and occasional amelioration of symptoms following dopamine blocking agents (Goodman et al., 1990 McDougle 1997). High-dose stimulant administration has been thought to produce simple stereotypies, rather than more complex compulsive or obsessive behavior however, compulsive symptoms have been observed in children with attention deficit disorder and hyperactivity during treatment with high-dose amphetamines (1 mg kg d-amphetamine or 2 mg kg methylphenidate) (Borcherding et al., 1990). For example, a 7-year-old boy spent several hours each evening vacuuming the carpet in his home, and another played with Lego blocks for 2 days, stopping only to eat and sleep. As in OCD, the children also became...

Disorders Of Impulse Control Tourette Syndrome

Tourette syndrome, obsessive-compulsive disorder (OCD), and attention deficit hyperactivity disorder (ADHD) commonly co-occur in clinical populations (Shapiro et al., 1988 Pauls et al., 1991 Leonard et al., 1992), supporting speculation that the conditions may share a common etiology (Peterson and Klein, 1997). The strongest evidence for a shared etiology comes from family studies of clinic patients. Those studies have shown that OCD is present in the families of probands who have TS more often than it is present in control families, whether or not the proband has comorbid OCD (Eapen et al., 1993). Conversely, tics are present in the family members of probands who have OCD more often than they are present in control families, whether or not the proband has a comorbid tic disorder (Grados et al., 2001). These findings suggest that a particular genetic vulnerability may be variably expressed as tics, as OCD, or as both disorders in combination. Although the familial...

Needs for Mentoring Creative Individuals

Not surprising, since these types of students are easier to manage in the classroom, which makes teachers' jobs easier. Finally, teachers' preference for conformity and order is so strong that they may even mistake creative behavior for behavior associated with attention deficit hyperactivity disorder (ADHD).

In Neuronal Transmission and in Multiple Behaviors

A variety of experimental animal paradigms exist for in vivo assessment of behavioral functions (98). The startle reflex (defined as the animal's response latency following stimulation elicited by an auditory stimulus) can be inhibited by a preceding stimulus (defined as prepulse inhibition) (99,100). The isolation-induced aggression paradigm assesses the animal's response to an intruding animal and reflects the level of hostility (98). The data derived can be extrapolated to human pathophysiology for example, deficits in prepulse inhibition (PPI) have been observed in patients suffering from schizophrenia (101), and PPI deficiency in rats can be corrected by antipsychotic treatment (102). Therefore, these experimental paradigms can be employed collectively to assess animal behavior. Compared to control animals, a -AR-- mice are hyperreactive to loud noises (i.e., display enhanced startle response) and display a deficit in PPI, whereas opposite findings were identified in a2C-AR+ +OE...

Can treatments cure children with ASDs

Deborah Fein and colleagues at the University of Connecticut are currently researching children who experience recovery from ASDs. Dr. Fein recognizes that children who move from autism to a behavioral picture of nonautism are in the minority (the actual numbers are unknown), but there are documented cases. In one study, Fein found that eleven children in her practice who initially presented with classic autism or PDD-NOS as young children no longer met the criteria for ASDs after receiving intensive ABA therapy. These children did show some minor residual behaviors and had some attention deficits and social problems, but the children were more similar to the typical ADHD child (who is social and wants friends but is somewhat impulsive and immature). In a second study, Fein and colleagues described fourteen children who moved from autism to nonautism. These children were all mainstreamed with no significant educational support and were receiving only minimal outside therapy, such...

Psychopharmacology Considerations

Considerable concern has been shown regarding the use of stimulant medications to treat attention-deficit hyperactivity disorder in the context of preexisting structural heart defects (Wilens et al. 1999). Although the risk of sudden death is thought to be greater while children with structural defects are taking a stimulant regimen, sudden death in children and adolescents is very rare, and the risk of sudden death may not be higher in children on stimulants than in the general population (Wilens et al. 1999).

Psychomotor Overexcitability

Some creators were highly spirited and energetic when they were young but were not so in their adult years. Chopin did not have a strong constitution to begin with and it was later weakened by tuberculosis. Once she returned from boarding school, the once lively Emily Dickinson gradually became so agoraphobic and fearful of strangers that she never again left her family house. Richard Wagner, Antoine de Saint-Exupeery, Sergei Rachmaninoff, and Thomas Alva Edison are a few examples of the many creators who as children were impetuous, hard to control bundles of energy. Today highly spirited gifted children are often mistakenly labeled as hyperactive or having Attention Deficit Hyperactivity Disorder (ADHD).

Mania In Children And Adolescents

The symptoms of mania and ADHD, oppositional disorder or conduct disorder, with the added complication of comorbid substance misuse, makes differentiation of mania from these disorders, and therefore diagnosis, difficult. Furthermore, Biedermen and others (1995) have diagnosed children of 12 years or younger with DSM-III-R mania and differentiated this group from children with ADHD using a Child Behavior Checklist (CBCL). In contrast, Biedermen and colleagues, (1999) could find no evidence to support this in a European sample the issue of possible U.S.-European differences in diagnostic practice remains unresolved.

What Practitioners Say It Does

Instruments that transmit sounds through the skin (cymatic therapy) are promoted to stimulate natural regulatory and immunologic systems. Practitioners claim that sound therapy in the form of rapid acoustic stimuli helps children with dyslexia. It is also claimed to help those with attention deficit disorder and other learning dysfunctions. The effectiveness of sound therapy is said to increase when used in conjunction with acupuncture.

Psychosocial Adjustment

PANDAS is associated with many comorbid psychiatric conditions. ADHD, affective disorders, and anxiety disorders were the most common comorbid psychiatric diagnoses associated with the 50 initial PANDAS patients. Swedo et al. (1998) also delineated the behavioral symptoms associated with exacerbation of PANDAS in the first 50 cases and found that the most common difficulties were emotional lability (66 ), changes in school performance (60 ), personality change (54 ), bedtime fears rituals (50 ), fidgetiness (50 ), separation anxiety (46 ), irritability (40 ), tactile sensory de-fensiveness (40 ), and impulsivity distractibility (38 ). These comorbid behavioral symptoms always occurred at the same time that the OCD and tics began or worsened and were associated with an increase in antistreptoccal antibody titers (Swedo et al. 1998). Antibiotic treatments that reduced the severity of OCD and tic behaviors also dramatically reduced these comorbid psychiatric conditions (Swedo et al....

Evidence Based Treatment

Important determining factors for pharmacological intervention are severity and duration of psychiatric symptoms and overall level of functional impairment. Symptomatic treatment includes pharmacological treatment of pain, movement disorders, seizures, spasticity, ADHD, and other psychiatric behavioral disorders in children with HIV-related CNS disease. Because the full gamut of developmental and childhood psychiatric disorders is seen in children and adolescents with HIV AIDS, common treatment for clinical disorders is briefly discussed. The reader is also referred to Chapter 30, Psycho-pharmacology in the Physically Ill Child. Adult psychiatric syndromes of adjustment disorder, major depression, anxiety, and delirium are seen in children as well. As in adults (Angelino and Treisman 2001), treatment of psychiatric syndromes in children and adolescents may improve outcomes. Psychostimulants are often used to treat ADHD in children with HIV, although dosing is not well established and...

Cognitive and Academic Effects

Inattention and impulsivity are the most consistent and significant psychiatric symptoms noted in children with new-onset epilepsy, even when controlling for demographic and seizure variables. At-tention-deficit hyperactivity disorder (ADHD) frequently occurs with children who experience a seizure disorder, with prevalence estimates as high as 38 . Patients tend to be inattentive, and it is not unusual for symptoms of ADHD to precede the epilepsy diagnosis. The disorder may be a more accurate predictor of school performance than either social or emotional factors (Williams et al. 2001). The risk factors associated with ADHD in epileptic patients are poor seizure control, additional neurological deficits, and specific antiepileptic medications including phenobarbital, benzodiazepines, topira-mate, vigabatrin, and zonisamide (Aldenkamp et al. 2003 Loring and Meador 2004). There have been concerns that the use of stimulant medication is contraindicated in children with epilepsy,...

Psychiatric Comorbidity

Oped a novel psychiatric disorder after a TBI. Max et al. (1997b, 1997c, 1997d, 1998e) conducted a series of studies following the development of new psychiatric disorders in a cohort of children with TBI at 3, 6, 12, and 24 months postinjury They found 46 of the participants met criteria for a new psychiatric disorder at 3 months, 24 at 6 months, 37 at 12 months, and 35 at 24 months postinjury. The most common psychiatric diagnoses were opposi-tional defiant disorder (ODD), attention-deficit hy-peractivity disorder (ADHD), and organic personality syndrome (now termed personality change due to TBI). Factors that predicted the presence of a psychiatric disorder at 2 years postinjury included injury severity, preinjury family functioning, and preinjury psychiatric history. Max et al. (2000, 2001) conducted additional studies specifically addressing the diagnosis of personality change due to TBI. These studies documented that personality change due to TBI is relatively common after...

Neurobehavioral Outcomes

Pediatric TBI is associated with a host of neurobe-havioral problems, although research in this area is often confounded by the high incidence of preinjury behavioral problems in children with TBI (Bloom et al. 2001 Brown et al. 1981). Asarnow and colleagues (Asarnow et al. 1995 Light et al. 1998) found that children with mild TBI displayed higher rates of pre-injury behavioral problems than did children with no injury. In contrast, their preinjury behavioral functioning did not differ from that of children with injuries not involving the head. The latter finding is consistent with previous research suggesting that the presence of premorbid behavioral problems actually increases the likelihood of traumatic injuries (Brown et al. 1981). Thus, although severe head injuries increase the risk of behavioral disturbance, it is also likely that behavioral disturbance increases the risk of head injury. Bloom et al. (2001) found that children with preinjury psychiatric disorders, such as ADHD...

Evidence Based Treatments

The literature on the use of psychotropic medications in the treatment of neurobehavioral sequelae of pediatric TBI is quite limited compared with the literature for adult TBI. Jin and Schachar (2004) conducted a systematic review of the literature on the use of methylphenidate in the treatment of ADHD symptoms after pediatric and adult TBI and found only modest evidence of efficacy. In contrast, Mahalich et al. (1998) found that the short-term use of methylphenidate after pediatric TBI led to improvements in multiple neuropsychological measures of attention and concentration.

The Internet and Mental Health

Researchers have shown that individuals with PIU typically meet criteria for a diagnosis of impulse-control disorder, not otherwise specified (Shapira et al. 2000). Co-occurring psychiatric and substance abuse disorders may be common among persons with severe PIU and may include depression, atten-tion-deficit hyperactivity disorder, and social phobia. (Ko et al. 2008 Yen et al. 2007). (Further examples are nearly infinite for a more detailed discussion of PIU as it relates to psychiatric symptoms and forensic psychiatry, see, e.g., Recupero 2008 and Goldsmith and Shapira 2006.)

Neuropeptide Medicines Still Waiting In The Wings

If one were currently to select a single neuropeptide that has had the most promising and most widely evaluated track record in humans, it would be the first item in the above list (i.e., Org-2766). This peptide emerged gradually from David de Wied's work on memory enhancing ACTH-related peptides (Kovacs and de Wied, 1994). It also proved to have various interesting neuroprotective effects after peripheral nerve injury as well as following damage to certain central systems such as DA pathways (Strand, 1999). Subsequent work on structure activity relations led to localization of activity in the ACTH-(4-10) fragment and to the synthesis of an array of orally active synthetic peptides, the most promising of which was called Organon-2766 This orally available, artificial peptide is about a thousand times as potent as the parent compound (ACTH 4-9), and has now been widely studied as a neuroprotective agent (e.g., van Rijzingen et al., 1996), and it has been reported to promote...

Two Childhood Disorders Debatable Examples Of Neuropeptide And Neurobehavioral Approaches

The first theoretically driven hypothesis concerning a neuropeptidergic imbalance in a major psychiatric disorder was the opioid-excess theory of early childhood autism (Panksepp, 1979). This idea, although now evaluated many times, remains neither well confirmed nor adequately disconfirmed. The second, ADHD, the most prevalent childhood problem of our times, can be well-managed pharmacologically, but there is

Ontario Child Health Study

This study sought to examine the prevalence of mental health problems and the utilization of mental health and social services among a sample of 4-16-year-old children residing in Ontario, Canada. See Boyle et al. (1987) and Offord et al. (1987) for detailed methodology. Briefly, a multistep random sampling scheme was used to ascertain a representative sample of male and female children residing in Ontario, Canada, using the 1981 Census of Canada. Four disorders were selected for study, based on their frequency and burden of suffering conduct disorder, attention deficit disorder with hyperactivity, emotional disorder, and somatization. The presence of these psychiatric disorders was based on four rating scales complied by the authors, consisting of a subset of items from the Child Behavior Checklist (CBCL). Respondents were asked to consider the past six months when answering each item. Each of these scales was meant to operationalize specific DSM-III criteria for a disorder or set of...

Parental Psychopathology

Studies have consistently found that psychopathology in parents is associated with mental disorders in offspring (Angold and Costello, 1995b). Of course, without adoption study methodology, it is extremely difficult to separate the genetic effect from the environmental effect when studying the impact of parental psychopathol-ogy. Nevertheless, it is informative to note findings that document the association between parent and offspring mental illness. For instance, it is a well-replicated finding that children of parents with substance use disorders are at increased risk for delinquency (West and Prinz, 1987) and alcohol use themselves (Jackson, 1997 Day, 1995a, b). Also, it was found that parental alcoholism was associated with attention deficit hyperactivity disorder, and conduct disorder, while antisocial personality disorder plus alcoholism was associated with oppositional-defiant disorder, adjusting for gender, age, and socioeconomic status (Kuperman et al., 1999).

Neuropsychological Tests

By John Ridley Stroop to assess interference in verbal processing (Golden and Freshwater 2002). It involves three tasks naming the color of dashes that appear in only three colors, reading the repeated list of the names of those colors printed in black ink, and, finally, naming the color of ink in which the list of the three color words is printed. The scoring is the differential in performance across the three tasks. The test is used in conjunction with other screening tests and shows potential for assessing the role of im-pulsivity versus distraction in adults with attention deficit disorder.

Characteristics of a Creative Student

Not surprisingly, teachers prefer students who are achievers and teacher-pleasers, rather than disruptive or unconventional creative students. Teachers frequently perceive creative student behaviors as 'misbehaviors.' Creative students often display characteristics disliked by teachers such as hyperactivity, argu-mentativeness, selfishness, stubbornness, and independence. Many of the traits associated with attention deficit hyperactiv-ity disorder (ADHD) also seem to be present in children who have been identified as gifted, talented, or creative. For example, compared with students who can focus attention easily, students with ADHD gather and use more diverse, nonverbal, and poorly focused information, and show higher fig-ural creativity. In fact, teachers may mistake a highly creative student who is energetic and unconventional as having ADHD. This disconnection between teacher's preferences and highly creative students may lead to a discrepancy between classroom expectations and a...

Pediatric Illness Falsification in the Child

Child Falsification Illness

Children are victimized by a variety of means, limited only by the perpetrator's imagination. They are subjected to unnecessary hospitalizations, tests, procedures, and treatments for disabilities that are physical, psychological, or educational (attention-deficit hyperactivity disorder ADHD and learning problems). Disease falsification includes symptom exaggeration and distortion false reports manipu In Ayoub's (2006) study of 30 children with MBP, 23 had gastrointestinal symptoms including vomiting, failure to thrive or grow, reflux, esophagi-tis, chronic secretory diarrhea, neurological intestinal pseudo-obstruction, and chronic abdominal pain 30 were reported to have recurrent seizures 20 had repeated episodes of apnea 13 experienced abnormal serum insulin levels either as uncontrolled diabetes or as unexplained hypoglyce-mia 10 were diagnosed with rare autoimmune or genetic disorders and 10 had unexplained exacerbations of asthma (Ayoub 2006). In addition, 7 were poisoned and had...

Evaluation Guidelines Table163

Attention deficit disorder and obsessive compulsive behaviors are frequent problems in tic patients Neuropsychological Tests. These tests help document cognitive and affective dysfunction that can be useful in determining diagnoses like Huntington's disease and also in guiding potential decisions regarding medical therapy. For example, when movement disorders are associated with depression or dementia, drugs that are associated with side effects like depression, confusion, or psychosis need to be avoided or used in reduced doses. Some movement disorders commonly co-exist with specific types of behavioral patterns, for example Gilles de la Tourette syndrome and attention deficit disorder or obsessive-compulsive disorder, and

Temperament and Personality

There is no evidence that either prenatal factors or delivery complications comprise risk factors for the development of anxiety disorders. The results of three studies that retrospectively assessed peri-natal events converged in linking such exposures to behavioral outcomes, but not to subsequent anxiety. For example, Allen et al. (1998) found that children who suffered from a variety of exposures ranging from prenatal substance use to postnatal injuries were more likely to develop behavior disorders, particularly attention deficit disorder and conduct problems, but not anxiety disorders. Likewise, the results of the Yale High Risk Study yielded no association between pre- and perinatal risk factors and the subsequent development of anxiety disorders (Merikangas et al., 1999).

Anorexia Nervosa and Bulimia Nervosa

Attention-Deficit Hyperactivity Disorder Resources from the national support group for children and adults with ADHD. Resources for clinicians and parents on ADHD from the National Initiative for Children's Healthcare Quality, including a number of assessment forms. www.add.org Resources from the ADD Association, a national ADHD adult support group. Information on ADHD from the National Institutes of Mental Health, including a link to current ADHD clinical trials. Resource Center on ODD by the American Academy of Child and Adolescent Psychiatry. Detailed assessment and treatment information on ODD and CD from a physician includes case examples. www.adhd.com.au conduct.html

Claus J Loland and Ulrik Gether

ADHD (amphetamines), Abbreviations CFT, MDMA, 3, 4-methylenedioxymethamphetamine MPP+, 1-methy l-4-phenylpyridinium (R)NFPS, propyl sarcosine NPTS, N- 3-phenyl-3-(40-(4-toluoyl) phenoxy)propyl sarcosine THPO, (4,5,6,7-tetrahydroisoxazolo 4,5-c pyridine-3-ol) ADHD, attention deficit hyperactivity disorder OCD, obsessive-compulsive disorder. Exo-THPO The examples of additional biogenic amine inhibitors include the GBR (from Royal Gist-Brocades) analogues that are highly selective for DAT and mazindol (Figure 14.4) that inhibits NET with one and two orders of magnitude higher potency than DAT and SERT, respectively. Finally, the amphetamine derivative methylphenidate (Figure 14.4) is a potent blocker of primarily DAT and NET, and often used for treatment of narcolepsy and attention deficit hyperactivity disorder (ADHD). Not much is known about the molecular basis for the interaction of these compounds with the transporters.

Gilles de la Tourette Syndrome and Other Tic Disorders

Clinical Manifestations and Associated Disorders.Tics are defined as simple or complex repetitive movements that occur out of background of normal motor activity. They are usually fast (myoclonic) but can be slow (dystonic). They increase with fatigue and after stress and decrease with concentration. y GTS is characterized by chronic waxing and waning motor and vocal tics, usually beginning between the ages of 2 and 21 years. It affects boys more frequently than girls. About half the patients start with simple motor tics, such as frequent eye blinking, facial grimacing, head jerking, or shoulder shrugging, or with simple vocal tics such as throat clearing, sniffing, grunting, snorting, hissing, barking, or other noises. Complex motor tics include squatting, hopping, skipping, hand shaking, and ritualized movements such as compulsive touching of objects, people, or self. Complex vocal tics include semantically meaningful utterances, including shouting of obscenities and profanities...

Special Populations

Comorbid conditions must be addressed in order to maximize desired outcomes. For comorbid bipolar disorder and attention deficit hyperactivity disorder when stimulant therapy is indicated, treatment of mania is recommended before starting the stimulant in order to avoid exacerbation of mood symptoms by the stimulant.

Patient Encounter Part 1

Which of the patient's symptoms are suggestive of ADHD What other information do you need to assess for ADHD Table 42-1 DSM-IV-TR Diagnostic Criteria for ADHD Based on the above criteria, ADHD can be divided into three types 1. ADHD combined type Both 1A and 1B. 2. ADHD inattentive type 1A criteria are met. 3. ADHD hyperactive-impulsive type 1B criteria are met. Adult ADHD is difficult to assess, and diagnosis is always suspect in patients failing to display clear symptoms prior to 7 years of age.4 Adults with ADHD have higher rates of psychopathology, substance abuse, social dysfunction, and occupational un-derachievement.

PANICSeparation Distress Grief and Social Bonding

We will cover the last emotional system in Table 21.1, playfulness, in the next section, as we consider two of the most controversial childhood psychiatric problems of our times, autism and attention deficit hyperactivity disorder (ADHD). The first has no adequate, generally accepted medications (although many psychotropics provide relief of specific symptoms), while the other has many adequate medicines, but professionals who prescribe them express little appreciation of the potential long-term brain mind changes that can be provoked in animals with psychostimulants such as methylphenidate and amphetamines (Moll et al., 2001 Nocjar and Panksepp, 2002).

What Family Problems Might I Encounter after an Illness Episode

Randy, a 45-year-old plumber, had two episodes of depression and several hypomanic episodes. His most recent episode, a depression, led to the loss of his job. His wife, Cindy, had a rudimentary understanding of bipolar disorder but was fairly intolerant of his apparent inability to function. She frequently spoke to him in derogatory psychiatric lingo That's your mania talking Last night when we got into that argument, you were totally rapid cycling You're doing your ADD attention deficit disorder thing again. In marital sessions, however, Cindy revealed that she really didn't believe his mood problems were of a biological origin. She blamed them

Assessing Development in the School Age Child

Developmental surveillance in a school-age child should focus on identification of unsuspected learning problems, including attention-deficit hyperactivity disorder (ADHD), mild mental retardation, and learning disabilities, as well as detection of emotional problems such as anxiety, depression, or school phobia. Emotional problems can be screened for using the Pediatric Symptom Checklist (PSC). The PSC is a one-page questionnaire that is relatively easy to administer and interpret during routine well-child care. Positive results should prompt the physician to probe

Roughand Tumble PLAYJoy System

Touch is essential for triggering normal play, and recent work suggests that animals besides humans also have tickle skin, stimulation of which facilitates playful moods. A laughterlike process has been identified even in laboratory rats (Panksepp and Burgdorf, 2003). Although our understanding of these brain systems remains incomplete, the implications for psychiatry may be profound. For instance, if new, affectively positive neurochemicals are discovered, they may find a niche in the treatment of depression. Linkages to the etiology of attention deficit hyperactivity disorders (ADHD) have also been proposed and evaluated in animal models with promising results (Panksepp et al., 2002, 2003). One idea that now needs to be tested is that abundant access to rough-and-tumble play during early development may facilitate If that turns out to be the case, as preliminary data suggest (Gordon et al., 2003), it is possible that sustained access to vigorous, emotionally positive, social...

Dilemma Of Psychiatric Diagnostics Dsms And Beyond

The extent to which diagnostic schemes are influenced by societal standards is highlighted by the disappearance of homosexuality as a psychiatric disorder in the more recent versions of the manual. Partly, this has arisen from the scientific evidence that to some degree homosexuality reflects a natural variation in the organization of gender-specific brain circuitries during the second trimester of gestation (Chapter 4). It also partly reflects the emergence of new human rights movements. Scientific advances and cultural tensions will continue to permeate diagnostic practices since some disorders are only extremes of normal human temperamental variability (especially among the Axis II disorders), while others, to put it metaphorically, are more likely to reflect broken parts in the brain (most abundantly in the severe Axis I disorders). The issue of attention deficit hyperactivity disorder (ADHD) is an especially poignant example since so many children are given medications that may...

Upon completion of the chapter the reader will be able to

Explain accepted criteria necessary for the diagnosis of attention-deficit hyper-activity disorder (ADHD). 2. Recommend a therapeutic plan, including initial doses, dosage forms, and monitoring parameters, for a patient with ADHD. 3. Differentiate between the available pharmacotherapy used for ADHD with respect to pharmacology and pharmaceutical formulation. 4. Recommend second-line and or adjunctive agents that can be effective alternatives in the treatment of ADHD when stimulant therapy is less than adequate. 5. Address potential cost-benefit issues associated with pharmacotherapy of ADHD. 6. Recommend strategies for minimizing adverse effects of ADHD medications.

Nature of the Required Accommodations

The DOE memorandum on pupils with ADD ADHD and several OCR rulings provide an explicit interpretation of school responsibilities to children who have handicaps that impair classroom performance but who do not qualify for special education and related services under IDEA. In its memorandum of 1991, DOE stated Should it be determined that the child with ADD ADHD is handicapped for purposes of Section 504 and needs only adjustments in the regular classroom, rather than special education, those adjustments are required by Section 504. DOE went on to state that through the use of appropriate adaptations and interventions in regular classes, schools effectively can address the instructional needs of many ADD ADHD (504-only) children. DOE identified more than 20 strategies available to meet the education needs of 504-only children with ADD ADHD. It is important to note that the kinds of accommodations required by 504 for students with impairments that affect classroom performance are...

Resistance to Thyroid Hormone

RTH is a rare disorder that results from target cell in-sensitivity to thyroid hormones. Newborn screening for congenital hypothyroidism can detect RTH if both T4 and thyroid-stimulating hormone are measured. The incidence of RTH is the same for males and females. Clinical presentation varies in individuals affected by RTH, and some people are asymptomatic. Behavioral characteristics (and their overall frequency) associated with RTH include emotional disturbances (73 ), attention-deficit hyperactivity disorder (70 ), hyperactivity (19 -42 ), learning disabilities (21 -32 ), and hearing deficits (25 ) (Hauser et al. 1993 Weiss and Refe-toff 2000). Limited data indicate that supraphysio-logical treatment with fast-acting thyroid hormone reduces the expression of both hyperactivity and im-pulsivity in children with RTH (Weiss et al. 1997).

Psychological implications

Another aspect of psychological parameters is represented by the group of externalizing behaviours these are predominantly found in males and have been associ-atedwith androgens (Zitzmann etal. 2001c Diagnostic and Statistical Manual ofthe American Psychiatric Association 1994). Respective personality traits are attention deficit hyperactivity disorder (ADHD) conduct disorder (CD) and oppositional defiant disorder (ODD). A controlled study in 302 younger men concerning these

Routes of Administration and Drug Formulations

Depending on age, disease, and disease severity, different routes of administration may be considered. Use of rectal route of administration is reserved in cases where oral administration is not possible and IV route is not necessary. Topical administration is often used for treatment of dermatologic ailments. Transdermal routes are often not recommended, unless it is an approved indication such as the methylphenidate transdermal patch for treatment of attention deficit hyperactivity disorder. The injectable route of administration is used in patients with severe illnesses or when other routes of administration are not possible. As done with adult patients, IV compatibility and access should be evaluated when giving parenteral medications. However, dilution of parenteral medications may be necessary to measure smaller doses for neonates. On the other hand, higher concentration of parenteral medications may be necessary for patients with fluid restrictions such as premature infants,...

Outcome evaluation

It is important to carefully document core ADHD symptoms at baseline to provide a reference point from which to evaluate effectiveness of treatment. Improvement in individualized patient outcomes are desired, such as (a) family and social relationships, (b) disruptive behavior, (c) completing required tasks, (d) self-motivation, (e) appearance, and (f) self-esteem. It is very important to elicit evaluations of the patient's behavior from family, school, and social environments in order to assess these outcomes. Using standardized rating scales (e.g., Conners Rating Scales Revised, Brown Attention-Deficit Disorder Scale, and Inattentive-Overactive With Aggression IOWA Conners Scale) in both children and adults with ADHD helps to minimize to determine efficacy of treatment and potential effects on height, weight, pulse, and blood pressure. Use physical examinations or liver function tests as appropriate to monitor for adverse effects. In children being considered for ADHD...

Epidemiology and etiology

In the United States, ADHD is the most common neurobe-havioral disorder that affects children.1-3,6 ADHD has been estimated to oc- cur in 4.3 to 12 of school-aged children. , ADHD tends to occur at a greater incidence in males than in females by approximately 3 1 in school-aged children.7 Although ADHD generally is considered a childhood disorder, symptoms can persist into adolescence and adulthood. The prevalence of adult ADHD is estimated to be 4 , with 60 of these adults having manifested symptoms of ADHD from childhood.8,9 Further, problems associated with ADHD (e.g., social, marital, academic, career, anxiety, depression, smoking, and substance-abuse problems) increase with the transition of patients into adulthood.

Patient Encounter Part

There may be similarities and differences in illnesses such as infections, asthma, allergic rhinitis, attention deficient hyperactivity disorder, diabetes, and seizure disorders between children and adults. These have been discussed throughout the textbook. The incidence of previously common childhood illness such as measles, mumps, and rubella has significantly decreased as a result of en masse vaccination of infants and children. The Advisory Committee on Immunization Practices (ACIP) within the CDC release and update child and adolescent immunization schedules every year. Patients' immunization records should be reviewed routinely for needed immunizations based on these schedules. , Most of the common illnesses in children leading to missed school and or need for clinician consultation are ambulatory in nature however, some complications may require hospitalization.

Child and Parental Adjustment to Type 2 Diabetes

Moreover, compared with individuals with type 1 diabetes, children and adolescents with type 2 diabetes have been shown to have a higher likelihood of being obese, being from an ethnic-minority group, and having lower socioeconomic status (Brody et al. 2008 Degazon and Parker 2007). Therefore, these individuals present with additional challenges beyond their illness. Discrimination and disparities in health care resources for ethnic minorities are well documented (Ahmed et al. 2007). Additionally, individuals who are obese have been shown to have psychological and emotional problems such as depression, low self-esteem, and discrimination (Braet et al. 1997 Miller and Downey 1999 Puhl and Brownell 2001). In a chart review of pediatric patients in Philadelphia, comorbid neuropsychiatric disorders, including attention-deficit hyperactivity disorder, autism, bipolar disorder, obsessive-compulsive disorder, and depression (among others), were found in 19.4 of children at the initial onset...

Purposes of Neuropsychological Examination

As with other psychological assessments, neuropsychological assessments can provide important information for educational planning, especially for children. Documentation of basic intellectual abilities helps determine appropriate classroom placement (e.g., enriched environment, special education) for school-age children. Such tests also aid in the identification of children with severe intellectual deficits, such as mental retardation. Differences between intellectual ability and academic achievement are used in the identification of specific learning disabilities. In neurological conditions like Gilles de la Tourette's syndrome, neuropsychological assessments can be an integral component to individual educational plans by identifying strengths and weaknesses in academic abilities, as well as indicating co-morbid conditions like attention deficit disorder, hyperactivity, and obsessive-compulsive behaviors.

Exercise Induced Asthma

Stimulant Therapy for Attention Deficit Disorder Attention-deficit disorder (ADD) affects an estimated 5 of the school-age population,37 with a growing trend toward the identification of impairment due to ADD among adults. Methylphenidate is the standard treatment for ADD with either hyperactive, inattentive, or mixed predominance of symptoms. Methylphenidate is also a stimulant with properties and side effects similar to those of other drugs in the amphetamine class, including an ergogenic effect mediated by delayed fatigue. Methylphenidate is banned by the IOC and the National Collegiate Athletic Association. However, the National Collegiate Athletic Association has recognized the utility of methylphe-nidate in helping student athletes with ADD to succeed academically. Therefore, a therapeutic use exemption exists for National Collegiate Athletic Association athletes with documented ADD and appropriate methylphenidate therapy.38

Longterm Goals

Maintain a program of recovery from addiction, and reduce the negative effects of Attention-Deficit Hyperactivity Disorder on learning, social interaction, and self-esteem. 3. Understand the relationship between Attention-Deficit Hyperactivity Disorder symptoms and addiction. 4. Develop the skills necessary to bring Attention-Deficit Hyperactivity Disorder symptoms under control, so normal learning can take place.

Cross Cultural Design

In one study, researchers sought to compare two sets of children and adolescents in Brazil who had been diagnosed with attention deficit hyperactivity disorder (ADHD). One group lived in a rural area, the other in an urban setting. The research question was whether the same emotional disorders (depression, anxiety) seen in American youth with ADHD also accompanied participants with ADHD in one or both Brazilian locations. Results showed that the same disorders were stable in (common to) youth with ADHD in all three locations, thus removing the issue of cultural differences.

Somatoform Disorders

Disorders of Childhood and Adolescence Attention Deficit Disorder (ADD) An ongoing pattern of inattention and or hyperactivity impulsivity (ADHD), with symptoms manifested before age seven and in two settings (e.g., school and home). Inattention symptoms include (1) making careless mistakes, (2) not paying attention, (3) not listening, (4) not following instructions, (5) being poorly organized, (6) avoiding tasks that require concentration, (7) losing things, (8) being easily distracted, or (9) being forgetful in daily activities.

Behavioral Factors

Such children may meet diagnostic criteria for a disruptive behavior disorder, such as oppositional defiant disorder or attention-deficit hyperactivity disorder, and parents of these children may benefit from parent training approaches to manage problem behaviors across settings (McMa-hon and Kotler 2008). For many children, however, oppositional behavior may be largely limited to feeding times, requiring a more focused approach on effectively managing and modifying feeding behaviors. For some children, oppositional behaviors develop due to medical conditions that can make eating difficult or painful (Manikam and Perman 2000). These children can develop anticipatory anxiety related to feeding, leading to refusal of food.

Paying Attention

When there are many things going on in a child's environment, he must pick out one thing at a time to focus on. This is selective attention. Children learn different strategies to avoid distractions. They might move away from certain stimuli, or, if it's an electronic gadget, turn it off. Although it sounds simple, many children experience difficulty in focusing and staying focused on the task at hand. In Chapter 16, a brain disorder called attention-deficit hyperactivity disorder, or ADHD, is described. This is a diagnosis given to children who have an extreme problem in this area.

Immunizations

More specific for ADHD and learning difficulties Symptoms of ADHD common comorbidities http www.nichq. org NIaCHQ Topics ChronicConditions ADHD Tools ADHD, Attention-deficit hyperactivity disorder. the IDEA. Conditions such as ADHD are covered by Section 504 of the Rehabilitation Act of 1973 (Henderson, 2001). The qualifications are broader under this law, allowing children with less serious issues to still receive special services. This assistance, though helpful, is often less extensive than if the child qualified for an IEP.

Comorbidity

The patterns of comorbidity among childhood-onset cases are generally comparable to those for adult samples, with tic disorders and specific developmental disorders appearing more frequently in the pediatric populations. The California HMO study found that attention deficit hyperactivity disorder (ADHD) occurred most commonly (34 percent), closely followed by major depression (33 percent), Tourette disorder (18 percent), oppositional defiant disorder (17 percent), and overanxious disorder (16 percent) (Fireman et al., 2001). The pattern of comorbidity found in this study was similar to that previously observed in the National Institute of Mental Health (NIMH) pediatric OCD cohort, where only 26 percent of the pediatric subjects had OCD as a single diagnosis. Tic disorders (30 percent), major depression (26 percent), and specific developmental disabilities (24 percent) were the most common comorbidities found. Rates were also increased for simple phobias (17 percent), overanxious...

Clonidine Commentary

Clonidine is an old drug, which has been used in the treatment of hypertension and of migraine, in angina, as an anxiolytic, as a treatment for glaucoma and as a nasal decongestant. It has also been used in conditions as diverse as neuropathic pain and attention-deficit hyperactivity disorder (ADHD). Anaesthesia has found new uses for the agent whose actions cannot totally be explained in terms of agonism at a2-adrenoceptors. It is an interesting drug, and so it would be preferable if you can convey some of your enthusiasm via direct experience of its use.

Conclusions

The genetic liability underlying each of these conditions seems uniquely to affect particular neural systems in each of the disorders. Mesial temporal lobe structures that subserve socialization functions seem to be especially important in autism arrest of development of the association cortices caused by the MeCP2 deletion may generate the symptoms of Rett syndrome the hippocampus and other regions involved in learning and memory are important in fragile X and disturbances in parietal cortices likely subserve visuospatial deficits affecting children with Williams syndrome. Abnormalities in frontal, temporal, and possibly parietal lobes likely subserve the psychotic symptoms and cognitive disturbances observed in childhood-onset schizophrenia. Disturbances in the structure and function of particular portions of CSTC circuits seem to underlie the symptoms of Tourette syndrome, obsessive-compulsive disorder, and attention deficit hyperactivity disorder the portions of the circuits...

Further Readings

Berquin PC, Giedd JN, Jacobsen LK, Hamburger SD, Krain AL, Rapoport JL, Castellanos FX (1998). Cerebellum in attention-deficit hyperactivity disorder. A morphometric study. Neurology 50 1087-1093. Biederman J, Milberger S, Faraone SV, Kiely K, Guite J, Mick E, Ablon JS, Warburton R, Reed E (1995). Family-environment risk factors for attention-deficit hyperactivity disorder. Arch Gen Psychiatry 52 464-470. Faraone SV, Biederman J, Weiffenbach B, Keith T, Chu MP, Weaver A, Spencer TJ, Wilens TE, Frazier J, Cleves M, Sakai J (1999). Dopamine D4 gene 7-repeat allele and attention deficit hyperactivity disorder. Am J Psychiatry 156 768-770.

Annette Sassi

This feature may not seem like it would necessarily support improvisation but it can help by providing intellectual channels that maintain attention to the core intellectual ideas. Rather than view scripts as constraining, I suggest that certain types of scripted materials, especially those designed to create collaborative learning opportunities, may offer teachers valuable guides for channeling discussions and ensuring that they stay within the intellectual focus of the curriculum. Indeed, some of the teachers I spoke with found this quality of the materials appealing. one teacher, who had been using materials by Pinnell and Fountas (e.g., Pinnell & Fountas, 2002) to design Workshop lessons, noted, . . . that was like a kid with ADHD, because the book is two inches thick and it has limitless material. But, you look through it and it's like where do I begin

Amphetamine Analogs

Amphetamines have been used for several decades to promote weight loss. They are also used in the treatment of attention deficit disorder and narcolepsy and as an adjunctive treatment in patients with treatment-resistant depression. During the 1960s and early 1970s, amphetamines were widely abused by people involved in the so-called counterculture movements. During the 1980s and 1990s, most of these drugs were replaced by cocaine. Nevertheless, prescribed amphetamines remained a significant source of abusable drugs. More recently, drugs such as methamphetamine (METH, Ice) and

Bipolar Disorder

Some children are troubled by alternating depressed and elevated moods. The child's mood undergoes large swings, shifting from one extreme to the other. Such children are said to be cycling between a high mood, also called mania, and a low state of depression. Bipolar disorder usually shows up in late adolescence or early adulthood, but it also can appear in younger children. It may begin in childhood as depression with or without periods of extreme irritation or as attention-deficit hyperactivity disorder, covered in Chapter 17 on children's learning disorders. Researchers at Stanford University's Pediatric Bipolar Clinic suggest that if a grandparent has bipolar disorder a grandchild has a much higher likelihood of having an anxiety disorder or attention-deficit disorder by elementary school age. If that child is not treated with therapy and or medication, he has a nearly 50 percent chance of developing full-blown bipolar disorder by the age of 15. If he does receive treatment, that...

Cognitive Issues

And difficulty concentrating on tasks that required short-term memory. Many of the cognitive problems that children experience after Lyme disease infection are similar to behaviors exhibited by children and adolescents with attention-deficit hyperactivity disorder (ADHD Healy 2000). Overall, after Lyme disease, general intelligence is not affected, but there are specific deficits related to auditory or visual sequencing tasks that can occur in children with chronic Lyme disease (Whitaker et al. 2002).

Cognitive Effects

Many patients with TSC experience comorbid learning, attentional, and developmental disorders. Those patients who do not meet strict criteria for ADHD nonetheless often demonstrate deficits in executive control processing that are associated with attention deficits and impaired goal-directed behavior. These individuals struggle to complete tasks that

Epilepsy

Epilepsy, a pattern of chronic recurrent seizures, is commonly encountered by the psychiatrist consulting to the pediatric setting. Childhood prevalence rates of epilepsy are estimated to range between 0.5 and 1 . Comorbidity rates of psychiatric disorders and epilepsy have been estimated to run as high as 60 , with attention-deficit hyperactivity disorder (ADHD), depression, and anxiety being the most commonly associated comorbidities (Plio-plys et al. 2007 Torres et al. 2008). Psychotropic medications can be used safely in the presence of epilepsy following consideration of potential interactions between the psychotropic agent of choice, the seizure disorder, and the indicated anticonvul-sant treatment. Any behavioral toxicity of anticon-vulsants used either alone or in combination should also be considered before proceeding with psycho-tropic treatment. Simplification of combination Antipsychotics are known to lower seizure threshold, with low-potency agents and clozapine...

Depression

By contrast, studies of the TCAs have shown no greater efficacy compared with placebo, and they are not currently recommended due to their unfavorable side-effect profile and risk of lethality following overdose (Boylan et al. 2007). However, clinical indications for their use at lower dosages exist for specified situations, for example, enuresis and migraine prophylaxis. There are data to support the use of venlafaxine in the treatment of adolescents with major depression (Bridge et al. 2005) and bupropion for children with comorbid major depression and ADHD (Daviss et al. 2001).

Case

Substantial research has shown that stimulant medication is effective in the treatment of ADHD (Angold, Erkanli, Egger, & Costello, 2000 DuPaul, Barkley, & Connor, 1998). Many school psychology practitioners and teachers have witnessed the dramatic improvements that occur for some children after they are placed on Ritalin. However, the use of Ritalin or other drugs to treat difficulties such as ADHD places the child at risk for physical or psychological harm because of the problems of potential misdiagnosis and drug side effects. A number of different types of hyperactivity exist, and stimulant medication is not appropriate for all types. Some children may be placed on Ritalin because of misdiagnosis, and use of the drug may consequently mask the child's true problems (Angold et al., 2000 Marshall, 2000). Based on our experiences in the schools, we believe that school personnel are sometimes too quick to suggest medication for children whose high activity level is a problem for...

Clinical History

In addition to these historical elements, a careful medical and family history is important in evaluating hypokinesia and hyperkinesia. The medical history should include an evaluation of all body systems, including the mind, because dementia, psychosis, depression, and various personality traits like attention deficit disorder and hyperactivity, and obsessive-compulsive disorder can help in diagnosis and co-morbidity analyses. Several primary movement disorders are hereditary, and therefore the creation of a family tree focusing on the type of movement disorder the patient has along with other neurological and psychiatric disorders may prove pivotal to the final neurological diagnosis.

Mitch Score Autism

ATTENTION DEFICIT DISORDER (ADD) A neurological disorder marked by a severe shortness of attention span, cognitive disorganization, and sometimes hyperactivity (ADHD). HYPERACTIVE A condition marked by chronic restlessness and the inability to concentrate for any length of time. Could be evidence of an attention deficit disorder.

Methamphetamine

Methamphetamine (also known as crank or ice) has been around for many years and has been used to treat obesity, Attention Deficit Hyperactivity Disorder (ADHD), and sleepiness. Its trade names include Adipex, Desoxyn, and Methedrine. It is also a major drug of abuse and a dangerous one at that. There has been literally a torrent of meth abuse, partly because it is highly addicting and partly because it can be synthesized easily, even in your kitchen. Not only is the drug toxic, but the synthesis of it, or cooking as it is called, is dangerous. There are many cases of severe burns and injuries to those making the drug. This substance is most similar to amphetamine but its effects are somewhat different. Meth gets into the brain more easily than amphetamine, causes more dopamine to be released into the synapse than amphetamine, and has been associated with more

Inorganic Lead

Clinical Features and Associated Findings. Acute signs of lead toxicity in children include listlessness, drowsiness with clumsiness, and possibly ataxia. With very high levels of lead, convulsions, coma, and respiratory arrest may occur. Therefore, a diagnosis of lead toxicity in a child should be considered when a child presents with a change in mental status, gait disorder, or a history of seizures. Chronic low-level lead exposure in children may result in behavioral disturbances, learning disabilities, attention deficit hyperactivity disorder (ADHD), or cognitive decline.