Attention-Deficit

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