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ADHD Helping Your Anxious Child Audio

ADHD Helping Your Anxious Child Audio

Has Your Child Been Diagnosed With ADHD Is Coping With Your Child's Behavior Wearing You Out Are You Tired of Searching For Answers An ADHD child does not have to have a dark cloud over his or her head. If You've Got Burning Questions About ADHD, I've Got Answers.

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The Parenting Adhd Resource Guide

You will find: 6 behavioral strategies. 6 behavioral strategies that you can use today to improve your child's behavior (page 52) The key to success. Why being Smart is the key to success with your child (page 53) The absolute best way. The absolute best way to tackle other people who say that Adhd is a myth and cop out for bad parenting (page 55) Rewards to improve your child's behaviors.Discover the exact type of rewards that you can use to improve your child's behaviors .and the exact type of rewards to avoid at all costs (page 57) 10 sure-fire techniques.10 sure-fire techniques to use when your child has problems in keeping attention; that will help them at home and in school (page 58) The real truth about Adhd and playing computer games.The real truth about Adhd and kids playing computer games (and believe me it's not what you might think.) (page 64) 8 practical tips.8 practical tips that you can use to deal with the challenges of a moody teenager with Adhd and reduce the conflict now (page 70) How to overcome the feelings of stress.How to overcome the feelings of stress and being overwhelmed when you are the parent of an Adhd child (page 74) The key actions.The key actions you must take if your Adhd child is becoming a danger at home; to make thing safer all round (page 79).

The Parenting Adhd Resource Guide Summary


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How To Conquer Add / Adhd

Number 1 Guide On How To Cope With Attention Deficit Disorder, Add Adhd. Inside this research collection, you will: Learn about Add / Adhd in Laymens Terms and find out more about the Keys to Success in dealing with the disorder. Cut to the chase reading. No wasting your time, your money and your patience. Arm yourself with knowledge about the causes and symptoms of Add / Adhd, in children and in adults. And find out where to go for testing and a diagnosis. Take action now to get started on the Success Path instead of plodding along on the Ignorance Trail. Uncover specific ways to help children (yours or someone elses) who have been diagnosed with Add / Adhd. Use our handy resources, network, learn more ways and get more help. Tailor strategies that work for Both you and the child. Read overviews about many successful treatment strategies along with detailed information about how to pinpoint specific options available in Your area (i.e. where You live). No more waiting to find out who can help or where to go. Print out our basic questions to ask when you are trying to learn more about Add / Adhd so that you can keep a journal of handy information for follow up reference and quick help along the way. Save money, time, aggravation, stress, hair from being pulled out, and much moreby Printing out and using our, How to Set Up and Use Organizer & Filing Systems, step-by-step action plan. Fill your notebook with your own planner sheets downloaded from our resource section and use them Now! No more waiting for a better day. Its here and its time to get organized. Continue reading...

How To Conquer Add Adhd Summary

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General Considerations for Modeling Attention Defect Hyperactivity Disorder 605411 Diverse clinical symptoms with

ADHD is a clinically heterogeneous neuropsychiatric disorder with symptomatic components of hyperactivity, inattention, and impulsivity that usually present during childhood but can remain into adulthood. There are no objective laboratory measures for the diagnosis of ADHD and, similarly, there is no one definitive animal model of ADHD. This is largely due to a reliance on assessment of behavioral phenotypes that likely result from one or more genetic or neurodevelopmental disturbances across interacting neuronal networks, as well as an incomplete understanding of neurotransmitter systems that subserve these fundamental behavioral functions. Nonetheless, individual behavioral symptoms are readily assessed in laboratory animals,18 and recent molecular biological19 and functional imaging studies20 are shedding light on the etiology of the disorder. environments can be tightly controlled. Thus, the researcher can avoid complications associated with many clinical studies such as...

Animal Models of Attention Deficit Hyperactivity Disorder 605421 The spontaneously hypertensive rat SHR

The most widely accepted animal model of ADHD is the SHR, a strain that was originally developed from Wistar Kyoto (WKY) rats in Japan more than 40 years ago. Unexpectedly, when selecting for hypertension, hyperactivity was also observed. Since then, the SHR has been studied extensively from face, predictive, and construct validity perspectives. SHRs exhibit many behavioral features characteristic of ADHD. Hyperactivity in the SHR strain is observed across multiple behavioral paradigms, including single- and multiple-compartment open-field as well as automated spontaneous locomotor tests. The nature of the hyperactivity is dependent on the test environment, with maximal disturbances compared to control rat strains observed in unfamiliar environments and more modest hyperactivity observed in the home cage.27 Excessive responding is also seen using fixed-interval extinction schedules.21 Fixed-interval schedules (pressing a lever for a food pellet that is only rewarded after a fixed...

Attention DeficitHyperactivity Disorder

Although stimulants have been the most extensively studied treatment for adult attention-deficit hyperactivity disorder (ADHD) (Levin, Evans, & Kleber, 1999), there are concerns that they may worsen the course of the SUDs or be subject to abuse themselves in dually diagnosed populations (Gawin, Riordan, & Kleber, 1985). At the same time, it has also been observed that a childhood history of ADHD worsens outcomes for cocaine dependence (Carroll & Rounsaville, 1993). Therefore, improving a patient's difficulties with inattention and hyperactivity may have beneficial effects on substance abuse as well (Levin et al., 1999). Consistent with this, prospective studies of children who received stimulant treatment for ADHD indicate that stimulants have a protective effect against future development of SUDs as an adult (Wilens, 2001). Although not as well-studied as stimulants, nonstimulant medications that lack abuse potential are possible alternatives in the treatment of ADHD. In adult...

Central Nervous System Disorders Psychiatric and Neurodegenerative

Disorders of the CNS are broadly categorized as either psychiatric or neurodegenerative with a major degree of overlap in symptoms. Thus neurodegenerative disorders also have a high incidence of psychiatric comorbities including anxiety and depression. Psychiatric disease includes a variety of disorders such as schizophrenia, depression, obsessive compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), and others. The underlying pathology is usually considered to be the result of synaptic dysfunction driven by (1) a dysregulation of neurotransmitter availability or (2) signaling, the latter at the receptor and or signal transduction levels. The net result is an alteration in neuronal circuitry involving multiple neurotransmitter neuromodulator systems.

Dopamine transporter polymorphisms

DAT terminates dopaminergic neurotransmission by reuptake of dopamine (DA) in presynaptic neurons and plays a key role in DA recycling. DAT can also provide reverse transport of DA under certain circumstances. Psychostimulants such as cocaine and amphetamines and drugs used for attention deficit hyperactivity disorder (ADHD) such as methylphenidate exert their actions via DAT. Altered DAT function or density has been implicated in various types of psychopathology, including depression, BPAD, suicide, anxiety, aggression, and schizophrenia. Altered transport properties associated with some of the coding variants of DAT suggest that individuals with these DAT variants could display an altered DA system.17'20 Multiple human dopamine transporter (hDAT, SLC6A3) coding variants have been described, though to date they have been incompletely characterized. The antidepressant, bupropion (6) dose-dependently increases vesicular DA uptake an effect also associated with VMAT-2 protein...

Dopamine transporter DAT knockout mouse

A recently developed animal model that may be relevant to ADHD is the DAT knockout mouse, which shows about a 300-fold decrease in the rate of clearance of extracellular dopamine42 due to the lack of the gene that encodes DAT-1. These knockout mice also show evidence of behavioral abnormalities similar to those observed in ADHD, although there remain several important issues regarding dopamine autoreceptor downregulation, serotonergic tone, and activation of trace amine receptors in these animals that need to be addressed with regard to relevance to ADHD.43 DAT knockout mice demonstrate a behavioral phenotype that, on the surface, appears to mirror symptomatology associated with ADHD.43 For example, hyperactivity was one of the earliest observations in these mice, which was subsequently revealed to be particularly sensitive to a novel environment, where locomotor activity was determined to be 12-fold higher in the knockouts compared with wild-type controls. Further, while locomotor...

Clinical Trial Issues

Despite the use of stimulant medications in the treatment of hyperkinetic children over 60 years ago, and the common observation that stimulant treatment for children with ADHD is arguably the best treatment, there are relatively few studies systematically investigating efficacy in patients with ADHD. Other issues in evaluating the efficacy of treatments are a lack of understanding as to how improvement on laboratory measures reflects the real-life impact of medication.8 In fact, a study suggests that there is a minimal agreement between laboratory and natural settings, especially when investigating drug effects.75 Finally, there is evidence to suggest that the laboratory paradigms do not truly reflect the school setting in which ADHD patients are involved, which includes test-taking and note-taking.8 Among the difficulties in clinical ADHD research arethe diagnostic criteria, and concerns about the validity of existing diagnostic criteria.6 Much of the focus on adult diagnostic...

Dsmivtr Diagnostic Criteria

There is a high rate of comorbidity among the three disorders that comprise the AD-DBD group and several other diagnostic categories Among the AD-DBDs, approximately 90 of children with CD would also meet the criteria for ODD. Furthermore, 40 of children with ADHD also have ODD and 40 of children with ODD have ADHD. In terms of the comorbidity of the AD-DBD group with other diagnostic categories, it has been estimated that 15-20 of children with ADHD have comorbid mood disorders, 20-25 have anxiety disorders and 6-20 have learning disabilities. Other conditions which may occur comorbidly with the

ADD and Brain Structure and Function

Scientists have access to technologies that enable them to view the brain in the same manner that X-rays help physicians check for broken bones. Some neuro-biologists, biologists who study the nervous system, use these technologies to find physical evidence in the brain structures of people diagnosed with Attention Deficit Disorder, or ADD. Some neurobiologists believe they have found subtle differences in the structure and function of the brains of people with ADD.

For the CoOccurring Psychiatric Disorder Has Abuse Potential

As evidenced in numerous studies, treating a co-occurring psychiatric disorder can often have positive outcomes in both reducing substance use and helping the specific psychiatric disorder for which it is prescribed. However, what if the pharmacological treatment has the potential to worsen or create a new SUD This dilemma is often considered in treating patients who suffer with SUDs and co-occurring anxiety disorders or ADHD, when clinicians ask themselves, Is it safe to prescribe stimulants benzodiazepines for this patient Pharmacotherapies that do not have abuse potential should be considered first-line treatments before prescribing stimulants or benzodiazepines in these populations (Ciraulo &Nace, 2000 Levin et al., 1999), and it is important that patients receive adequate trials (i.e., dose and duration) of these medications before they are abandoned. Psychosocial treatments with demonstrated efficacy should also be tried before prescribing an abusable medication. For example,...

Overview and Comparison of Drug Classes

Historically the treatment of ADHD relied on agents affecting monoaminergic neurotransmission, and largely consisted of the stimulants, antidepressants, and antihypertensive agents (Table 1).1'65 The primary pharmacological treatment for ADHD continues to be the use of stimulants, particularly methylphenidate and amphetamines. Methylphenidate has long been the leading treatment for ADHD however it has a short duration of action and a midday dose is required. In schoolchildren, this necessitates dosing during the school day and contributes to poor compliance and social stigma. The importance of avoiding this midday dose is underscored by the success of Concerta (J & J), a novel formulation of methylphenidate designed to provide both rapid and sustained release, and Adderall XR (Shire), a QD formulation of mixed amphetamine salts. The first nonstimulant therapy designed for ADHD, Strattera (atomoxetine, Lilly), was introduced in January 2003 and has rapidly gained acceptance....

Frequently Cooccurring Symptoms and Disorders

Ascertained subjects with Tourette's disorder. These co-occurring problems can be more disabling than tics and are often the reason people with tics come to clinical attention. The nature and range of these problems is broad and includes problems with mood, impulse control, obsessive-compulsive behaviors, anxiety, attention and learning problems, and conduct problems. In some individuals, these problems reach diagnosable proportions, but in many others, they are less severe and do not fulfill diagnostic criteria. The most common co-occurring disorders are ADHD (50-60 ) and OCD (30-70 ). The exact relationship of these problems to Tourette's disorder is unclear.

Differential Diagnosis

Attention-Deficit Hyperactivity Disorder. Young children with RAD, disinhibited type, demonstrate a persistent pattern of socially impulsive behavior. These behaviors must be distinguished from the im-pulsivity that characterizes ADHD. Complicating the distinction is evidence that a syndrome of inattention and overactivity may develop in the context of institutionalization. Although ADHD and the disinhibited type of RAD may be associated with social impulsivity, there is no reason to expect children with disinhibited RAD to manifest inattention or hyperactivity. If, on the other hand, the child meets criteria for both disorders, both diagnoses should be assigned.

In Search and Discovery of Potential New Therapeutic Indications

Because wake and vigilance are essential requirements for attention, learning, and cognition, research on these topics has also been undertaken in animals. Modafinil was found to induce a faster learning rate in a serial spatial discrimination task, demonstrating an improvement of learning processes following acute75,76 and chronic administration in mice77 and facilitating performance on a delayed nonmatching to position swim task in rats.78 In healthy human volunteers without sleep deprivation, modafinil had subtle stimulating effects on maintenance and manipulation processes in relatively difficult and monotonous working memory tasks, especially in lower-performing subjects.79 In addition, in healthy volunteers, modafinil produced a selective improvement of neuropsychological task performance, attributable to an enhanced ability to inhibit prepotent responses, leading to a reduction of impulsive responding, that appears to be beneficial in the treatment of ADHD.80 Based on this...

Histamine receptor antagonists

Of the four members of the histamine receptor superfamily, the H3 is predominately expressed in the brain, localizing to cerebral cortex, amygdala, hippocampus, striatum, thalamus, and hypothalamus. H3 receptors are localized presynaptically on histaminergic nerve terminals and act as inhibitory autoreceptors thus, when activated by histamine, histamine release and biosynthesis are blocked.38 Of relevance to AD, H3 receptors expressed on nonhistaminergic nerve terminals can modulate the release of ACh, DA, g-amino-butyric acid (GABA), glutamate, and serotonin. Thus, H3-receptor antagonists or inverse agonists, by blocking the inhibitory effects of histamine, will facilitate the release of multiple neurotransmitters, reminiscent of the effects of nAChR activation. H3-receptor antagonists enhance vigilance, promoting wakefulness in rats, mice, and cats, and improve cognitive function in a variety of preclinical models. H3-receptor inverse agonists are thus being targeted as therapeutics...

In Search and Discovery of Potential New Therapeutic Indications Conclusions

The search for additional indications for modafinil was directed toward diseases associated with wake deficit and somnolence but also to those in which symptoms could be related to cognition deficits, with modafinil showing human efficacy in attention deficit hyperactivity disorder (ADHD). Preclinical studies also showed a beneficial effect of modafinil in models of depression.

Impulse Control Disorders Not Elsewhere Classified

As is suggested by the title of this diagnostic grouping, no one diagnostic class in DSM-IV-TR comprehensively includes all of the impulse control disorders. A number of disorders characterized by impulse control problems are classified elsewhere (e.g., conduct disorder, attention-deficit hyperactivity disorder, oppositional-defiant disorder, delirium, dementia, substance-related disorders, schizophrenia and other psychotic disorders, mood disorders, antisocial and borderline personality disorders). What ties together the disorders in this class is that they present with clinically significant impulsive behavior and that they are not better accounted for

Adolescents Club Drugs and the Rave Scene

Ders, as well as attention-deficit hyperactivity disorder. Although club drugs originally got their name from nightclubs and raves, adolescents and young adults now use club drugs in both club and nonclub settings (Rosenthal & Solhkhah, in press). Overall, studies of typical MDMA users reveal high rates of multiple drug use (Parrott, Milani, Parmar, & Turner, 2001 Parrott, Sisk, & Turner, 2000 Rodgers, 2000 Schifano, Di Furia, Forza, Minicuci, & Bricolo, 1998). Among treatment seekers, heavy MDMA use is associated with increased psychopathology (Parrott et al., 2000 Schifano et al., 1998). In addition to use of alcohol and cannabis, the heavier the MDMA use, the more likely is the co-use of stimulants and hallucinogens (Scholey et al., 2004). MDMA as a sole drug of abuse is an uncommon phenomenon thus, it is a reasonable proxy for abuse of multiple substances (Rodgers, 2000).

Psychiatric Comorbidity And Sequelae

Attention-deficit hyperactivity disorder (ADHD) is an important comor-bid condition. In a large longitudinal study, approximately 21 of adults with ADHD were cocaine dependent, compared to 10 of agemate controls (Lambert & Hartsough, 1998). Studies indicate that between 12 and 35 of cocaine addicts meet childhood criteria for ADHD (Carroll & Rounsaville, 1993 Levin, Evans, & Kleber, 1998 Rounsaville et al., 1991). Compared to cocaine abusers without comorbid ADHD, those with ADHD are more likely to be male and to also meet criteria for conduct disorder and antisocial personality disorder. Cocaine abusers with ADHD evidence earlier age of onset of use, more frequent and severe use, more alcoholism, and more prior treatment episodes. Men who score high on an ADHD measure also report more use of cocaine for the purpose of self-medication (Horner, Scheibe, & Stine, 1996). Although somewhat controversial, several case reports suggest that stimulants (e.g., magnesium pemoline, and...

Psychiatric Disorders 601411 Schizophrenia

Pervasive developmental disorders, e.g., autism Attention deficit and disruptive behavior disorders, e.g., ADHD Attention deficit hyperactivity disorder Attention deficit hyperactivity disorder (ADHD (see 6.05 Attention Deficit Hyperactivity Disorder)) is one of the most common childhood psychiatric disorders. An estimated 5-10 of children worldwide are afflicted by ADHD. In addition, there is now increasing acceptance that ADHD occurs in adulthood in approximately 4 of the population. DSM-IV-TR diagnostic criteria classify ADHD symptoms under the headings of inattention or hyperactivity-impulsivity. Symptoms of inattention include lack of attention to detail, carelessness, difficulty in sustaining attention, difficulty in organizing and completing tasks, ease of distraction, and forgetfulness. Hyperactivity-impulsivity includes symptoms such as fidgeting or squirming, excessive and inappropriate running or climbing or a feeling of restlessness, excessive talking,...

Choosing behavioral assays

Testing paradigms utilized by different laboratories can vary but tend to revolve around using so-called standard assays, e.g., open-field automated locomotor activity in a novel environment and general tests of cognitive function, e.g., the water maze, radial arm maze, or passive avoidance paradigm. While versions of the open field are sensitive to showing the hyperactivity component of ADHD and are useful for demonstrating face validity, standard tests of cognitive function are arguably less demonstrative in that behavioral domains affected in ADHD (e.g., decreased response inhibition or impulsivity, inattention) are not specifically addressed. Therefore, more sophisticated tests are desirable. Three such tests of varying degrees of complexity are used routinely by others or us. These include (1) fixed-interval extinction schedule operant responding, where rodents are required to withhold responding (usually pressing on a lever) for a defined time period (up to several minutes) for...

Comparison Of Dsmivtr And Icd10 Diagnostic Criteria

For attention-deficit hyperactivity disorder, the item set chosen for the ICD-10 Diagnostic Criteria for Research is almost identical to the items in the DSM-IV-TR criteria set but the algorithm is quite different, resulting in a more narrowly defined ICD-10 category. Specifically, whereas the DSM-IV-TR algorithm requires either six inattention items or six hyperactive impulsive items, the ICD-10 Diagnostic Criteria for Research requires at least six inattention items, at least three hyperactive items, and at least one impulsive item. Instead of subtyping the disorder on the basis of the predominant type, ICD-10 subspecifies the condition whether criteria are also met for a CD.

Disease State

ADHD is characterized by (1) the inattentive (2) the hyperactive impulsive (hyperactivity without inattention) or (3) the combined type.1 The condition arises before the age of 7 and frequently persists through adolescence and into adulthood, although the behavioral features of the condition vary at different ages. Children with the hyperactive impulsive subtype usually develop symptoms of ADHD by 4 years of age, with significant difficulties contributing to academic challenges by the age of 8. In contrast, children with the inattentive subtype tend to develop difficulties later, with a typical age of presenting with noticeable difficulties around 9-10 years of age. In adolescence, the hyperactive and impulsive symptoms may become less evident, but the problems with inattention often persist. Generally ADHD is assumed to have a ratio of 10 1 (boys to girls) based on clinical estimates, while community estimates are 3 1. In adult samples, the ratios of men to women are approximately...

Disease Basis

Until relatively recently, controversy surrounded the status of ADHD as a genuine medical condition. It was commonly believed that ADHD was a childhood reaction to poor parenting or family stress. However, recent findings that ADHD is found in a variety of cultures and that there is a strong genetic component bolster the validity of designating ADHD as a medical disorder.11 ADHD is likely a polygenic disorder, meaning that multiple genes contribute, each conferring a small risk. Candidate gene searches have focused on the dopaminergic system, in part due to the effective medications acting primarily on this neurotransmitter system (for a review of pharmacogenomic ADHD studies, see 13). Genes that have been associated with ADHD include the dopamine transporter (DAT1), dopamine D2 (DRD2) and D4 (DRD4) and D5 receptor (DRD5) subtypes, and the dopa-b-hydroxylase gene (DBH).13 Recently, an intron mutation in the gene coding for the a4 subunit of neuronal nicotinic receptors (NNRs) was...

Unmet Medical Need

Adult ADHD represents a relatively untreated condition. In adults, the hyperactive component is less pronounced and the attention deficit a larger treatment issue than in adolescents. ADHD is not just a lifestyle condition in that inattention and impulsivity result in significant functional impairment and have negative occupational and interpersonal consequences. Impulsivity and the resulting impaired risk assessment also contribute to a higher incidence of illicit drug use among ADHD patients. From a research perspective, there is a need for objective diagnostic tools and indicators to predict which drug will be the most effective therapy for a given patient. Approximately 70 of children with ADHD respond positively to stimulants as first-line therapy. Additionally, roughly two-thirds of children who do not respond to the first stimulant usually respond to another type (i.e., Adderall or methylphenidate, or vice versa). Hence, the total response rate appears to be about 90 . Overall,...

New Research Areas

In conclusion, it is clear that we have come a long way in the more than 60 years since serendipity led to the observation that amphetamine can reduce symptoms in hyperkinetic children. We now have a clear understanding of ADHD as a bona fide disorder, have interesting animal paradigms to model aspects of ADHD, have diagnostic criteria for adolescents, and have therapies that successfully treat the majority of patients, albeit with some limiting side effects. Ongoing research and future directions are clearly going to enhance our ability to understand, diagnose, and treat ADHD successfully in all populations. One promising new molecular target is the histamine H3 receptor, where inverse agonists have shown some efficacy in animal models of ADHD.96 83. Biederman, J. Spencer, T Pharmacotherapy of Attention Deficit Hyperactivity Disorder Nonstimulant Treatments. In N1H Consensus Development Conference on Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder Jensen, PS....

Somatic Treatments

At this time, there are no pharmacological agents with US Food and Drug Administration (FDA) approved labeling specific for the treatment of autistic disorder or other PDDs in either children or adults. This is all the more problematic because many of the symptoms commonly seen in autistic disorder and other PDDs (rituals, aggressive behavior, and hyperactivity) are also commonly seen in children, adolescents, and adults with mental retardation but without a PDD. Some of the pharmacological strategies for the treatment of autistic disorder have been extrapolated from studies of related conditions, largely in adults, including attention-deficit hyperactivity disorder and OCD. While there may not be FDA-approved treatments, there are treatment options available. However, clinicians and families should be reminded before any treatment is initiated that (1) current treatments target symptoms, (2) current treatments do not target a specific etiological mechanism for ASD, (3) anecdotal...


Methylphenidate, 8, and its D-isomer dexmethylphenidate, are stimulants structurally different from amphetamine, that are used for the treatment of ADHD. Mechanistically, the methylphenidates block monoamine uptake (DA NE 5HT) but have less effect on reverse amine efflux or VMAT function than amphetamine64 and the primary pharmacological stimulant effect is dopaminergic.65 Methylphenidate was introduced for the treatment of narcolepsy in 1959 and is the most widely prescribed psychostimulant.64 The more potent D-isomer has a half-life of 6h contributing to its greater usage compared to amphetamine. Various slow-release formulations of these drugs are also available. Side effects for methylphenidate include increased blood pressure, palpitations, appetite suppression (less than observed with amphetamine), tremor, and insomnia. Pemoline, 9, is similar in its pharmacology to amphetamine but is a milder stimulant with less potent sympathomimetic properties, a slower onset of action, and a...


Successful treatment planning in children with AD-DBDs requires consideration of not only the core symptomatology but also of family and social factors and comorbidity with other disorders. Given the heterogeneity of the three disorders that make up the AD-DBDs, the wide-ranging effects of the disruptive behaviors, the high rates of comorbidity, and the presence of associated features such as learning disabilities, multimodal treatments (i.e., psychopharmacologic and psychosocial) are almost always warranted. Nevertheless, good response can be achieved with either treatment alone in certain instances (e.g., medication treatment for uncomplicated ADHD or ADHD + ODD psychosocial treatment for ADHD + anxiety disorder). A diagnosis of ODD without any comorbid condition will usually be responsive to behavioral intervention without medication. One should always attempt, however, to rule out the possibility that ADHD is also present. Similarly, treatment of children with CD without...


Some behaviors characteristic of the AD-DBDs are observable as early as the preschool years. Hyperactiv-ity and attentional problems emerge gradually and may overlap with the emergence of oppositional behaviors, giving the appearance of a simultaneous, rather than a sequential, onset. It is now recognized that while hyperactivity and, to a lesser extent, attentional problems show a gradual decline through adolescence and adulthood, many individuals with ADHD continue to have attentional, behavioral and emotional problems well into adolescence and adulthood. Typically, adults with ADHD are less overtly overactive, although they may retain a subjective sense of restlessness. Impairment in these adults is more often a result of inattention, disorganization, and impulsive behavior. Considerable data indicate that a subgroup of hyperactive children show high rates of delinquency and substance abuse during adolescence, and this continues into adulthood. However, it is likely because of the...

Combined Treatments

The 1997 multimodal treatment study of children with ADHD (MTA) was a landmark multisite clinical trial, conducted at six performance sites across the US and Canada, that examined the comparative response to 14 months of medication and psychosocial treatments, administered alone or together, in 579 seven- to nine-year-old children with combined subtype ADHD. The principal objectives of the study were to determine the relative effectiveness of the three active treatments in comparison to one another, and in comparison with community standard care. The study indicated that, for ADHD symptoms, treatments that included medication performed better than other treatments in reducing ADHD symptoms. For non-ADHD symptoms, only combined treatment was statistically superior to the community standard care, although it was not different from the medication group.

Diet Hyperactivity

Breakfast is the crucial meal for children with ADHD. Skipping breakfast can cause drops in blood sugar that can trigger restlessness and irritability.16 Breakfasts high in protein and calcium have a calming influence in many children and improve learning capability in ADHD. Children may be sensitive to high amounts of phosphates present in certain foods, including sausages, processed foods, milk products, and soft drinks. Food sensiti-vites can produce or aggravate ADHD.15, 20,21 Artificial food colors and flavors, as well as foods containing natural salicylates may trigger ADHD, and the Feingold Diet may be helpful in some children with hyperactivity.22 Foods to be avoided in children with ADHD (the Feingold Diet)22