Attention-Deficit
Hyperactivity Disorders
REBECCA J. HAMBLIN AND ALAN M. GROSS
OVERVIEW
Attention-deficit/hyperactivity disorder (ADHD)
is one of the most well-studied child psychopathologies,
and a tremendous amount of
research has been published related to its
etiology, primary problems and impact,
demographic and contextual variability, and
treatment methods. The label has also received
heavy criticism as being an artificial U.S.
construct for labeling normally exuberant
children; however, early clinical descriptions
of attention impairments date to 1798 (Barkley,
2006; Palmer & Finger, 2001). Attentiondeficit/hyperactivity
disorder symptoms are
reported to occur in all countries in which
ADHD has been studied (Polanczyk, de Lima,
Horta, Biederman, & Rohde, 2007). Despite
early conceptualization of the disorder as
resulting from poor character or wayward
parenting, ADHD is now seen as a neurologically
based disorder (Barkley, 2006).
ADHD is one of the most common disorders
of childhood, affecting an estimated
3% to 5% of children in the United States,
and is the most common reason for clinical
referral of children to psychiatric clinics
(American Psychiatric Association, 2000).
Children with ADHD display symptoms of
inattention, impulsivity, and hyperactivity
across multiple situations beginning at an
early age. The frequency of these behaviors
is out of bounds with respect to normal
development, and symptoms cause significant
impairments in family and peer relationships,
academic functioning, and emotional wellbeing
(Barkley, 2006).
This chapter will provide an overview of the
core symptoms and current diagnostic features
of the disorder, describe its prevalence and
epidemiology, impairments to daily life,
comorbid disorders, and long-term outcomes.
The next sections will describe various
psychosocial treatments that have been
empirically explored, and will review the most
current research on treatment efficacy. The
chapter concludes with a summary and list of
evidence-based treatments for ADHD.
CORE SYMPTOMS
Inattention
Relative to children without ADHD, those
with the disorder have difficulty maintaining
attention or vigilance in responding to environmental
demands. That is, they have trouble
sustaining effort in tasks, particularly for
activities that are tedious, difficult, or with
little intrinsic appeal (Barkley, 2006). In the
classroom setting, impairment in attention and
task vigilance may be evident in inability to
c10 21 April 2012; 9:57:7
243 Hersen, Michel, and Peter Sturmey. Handbook of Evidence-Based Practice in Clinical Psychology, Child and Adolescent Disorders, John Wiley &
Sons, Incorporated, 2012. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ashford-ebooks/detail.action?docID=817355.<br>Created from ashford-ebooks on 2017-11-28 18:25:28. Copyright © 2012. John Wiley & Sons, Incorporated. All rights reserved.
complete independent assignments or listen
to class instruction. In unstructured settings,
inattention may be apparent in frequent shifts
between play activities. Parents and teachers
report that these children have difficulty
focusing, are often forgetful, lose things, frequently
daydream, fail to complete chores and
schoolwork, and require more redirection
and supervision than others the same age.
Children with high levels of inattentive
symptoms in the absence of hyperactive or
impulsive symptoms may also have a different
kind of attention problem marked by sluggish
cognitive processing and deficiency in selective
attention (Barkley, 2003).
Hyperactivity and Impulsivity
Hyperactivity and impulsivity almost always
co-occur and are therefore considered a single
dimension of ADHD. The hyperactiveimpulsive
dimension of the disorder is often
conceptualized as behavioral disinhibition.
Hyperactivity is displayed in fidgeting, restlessness,
loud and excessive talking, and
excessive levels of motor activity. Impulsive
behaviors include interrupting or intruding on
others, difficulty waiting and taking turns, and
blurting out without thinking. Children
and adolescents with hyperactive-impulsive
features are described by caregivers as reckless,
irresponsible, rude, immature, squirmy,
and on the go (APA, 2000; Barkley, 2006).
Diagnostic Criteria and Subtypes
Diagnostic criteria for ADHD are defined by
the Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition, Text Revision (DSMIV-TR)
as presence of several symptoms in
inattention, hyperactivity-impulsivity, or both,
as seen in Table 10.1 (APA, 2000). Individuals
with symptoms in both domains are classified as
having ADHD, combined type (ADHD-C).
Those who manifest multiple symptoms of
inattention but no or few hyperactive-impulsive
characteristics are diagnosed with ADHD,
predominately inattentive type (ADHD-PI).
The ADHD, predominately hyperactiveimpulsive
type (ADHD-PHI) describes individuals
with behavioral disinhibition without
significant symptoms of inattention. Table 10.1
contains the complete diagnostic contained in
the DSM-IV-TR.
PREVALENCE AND DEMOGRAPHIC
VARIABLES
Nearly 5 million children in the United States
are diagnosed with ADHD (Centers for Disease
Control and Prevention [CDC], 2005).
Prevalence rates of ADHD translate, on average,
to one to two children in every classroom
in America (APA, 2000). The most commonly
diagnosed subtype is ADHD-C, representing
about 50% to 75% of children diagnosed.
Another 20% to 30% are classified with
ADHD-PI, while fewer than 15% are diagnosed
with ADHD-PHI. It is thought that
ADHD-PHI may be a developmental precursor
to the combined type, seen in preschool-age
children who have not yet manifested symptoms
of inattention.
Boys are 2 to 9 times more likely than girls to
be diagnosed with ADHD (APA, 2000). The
gender discrepancy is more pronounced in
clinic referred than in community samples.
Higher rates among males may be at least
partially attributable to a stronger tendency for
males to present ADHD-C and comorbid disruptive
behavior disorders, which are more
likely to rise to the level of clinical attention.
Girls are more likely to have ADHD-PI and
comorbid disorders are more likely to be
internalizing disorders. Because symptoms of
ADHD-PI and emotional disorders are more
likely to go unnoticed, girls with ADHD
may be underindentified and undertreated
(Biederman, 2005).
ADHD is present among all socioeconomic
levels and ethnic groups within the United
States, though prevalence and symptoms vary
by gender, age, and ethnicity (Barkley, 2003;
244 Specific Disorders
c10 21 April 2012; 9:57:7
Hersen, Michel, and Peter Sturmey. Handbook of Evidence-Based Practice in Clinical Psychology, Child and Adolescent Disorders, John Wiley &
Sons, Incorporated, 2012. Pro
