The purpose of this post is to address the four discussion prompts as instructed.
1. What are the most current evidence-based assessment strategies for diagnosing ADHD in children and adolescents?
Attention deficit hyperactivity disorder (ADHD) is a diagnosis of exclusion (Rojas, 2012). ADHD is a behavioral diagnosis without specific diagnostic medical test; diagnostic criteria based on the diagnostic and statistical manual of mental disorders fifth edition (DSM-5) is most useful for diagnosis (Boland et al., 2021; Rojas, 2012). Diagnosis of ADHD requires information from two settings where the child spends most of his or her time, like at home and school or at school and social situation (Boland et al., 2021; Krull, 2021; Rojas, 2012; Yearwood et al., 2012). In order to consider differentials, diagnosis for ADHD includes developmental variations, neurologic or developmental conditions, comorbid features, emotional and behavioral disorders, psychosocial or environmental factors, and certain medical problems (Boland et al., 2021; Krull, 2021; Yearwood et al., 2012). While ADHD is a neurodevelopmental disorder, it is also critical to consider and differential age-appropriate behaviors in children and adolescents that may seem like unusual character.
2. ADHD-specific scales (or narrowband scales) are designed to focus on ADHD symptoms (inattentive, hyperactive-impulsive) and can determine the presence of core symptoms of ADHD as defined by the Diagnostic and Statistical Manual (DSM-5) criteria for ADHD. Please provide an example of a scale and how it is useful in making a diagnosis of ADHD.
An example of narrow-band assessment is ADHD Rating Scale which assesses symptoms of ADHD according to DSM-5 criteria. This scale allows a clinician to assess symptoms or behaviors over a long period of time including the last six months (Krull, 2021). This scale can be used to assess for the initial diagnosis of a child with ADHD and to monitor the treatment strategy.
An example of a broadband assessment is Conners 3rd edition which assesses inattention, hyperactivity/impulsivity, learning problems, executive functioning, aggression, peer relations, DSM-V symptoms scales for inattentive, hyperactive-impulsive and combined type of ADHD. Other examples of broadband assessment tools are Behavior Assessment System for Children (BASC) and Child Behavior Checklist/Teacher Report Form (Krull, 2021).
The Side Effects Rating Scale is used to assess medication side effects: sleeping, appetite problems, staring/daydreaming, withdrawal, anxiety, irritability, somatic complaints, emotional lability, dizziness, tics (Krull, 2021).
3. What clinical findings during the history taking and examination of a child or adolescent with ADHD symptoms might lead you to a diagnosis of bipolar disorder? Why is it important to consider bipolar disorder in your differential diagnoses?
When assessing for ADHD, it is vital to identify coexisting emotional, behavioral, and medical disorders such as mood disorders, anxiety, learning disabilities, or sleep disorders (Krull, 2021). It is difficult to diagnose children with ADHD who may have overlapping symptoms associated with bipolar (Boland et al., 2021; Yearwood et al., 2012). Overlapping core symptoms of ADHD and bipolar include inattention, hyperactivity, impulsivity, and aggression (Boland et al., 2021; Yearwood et al., 2012).
One way to different these two conditions is that children or adolescents with ADHD do not tend to have elevated mood, grandiosity, decreased need for sleep, and racing thoughts (Boland et al., 2021; Yearwood et al., 2012). If children present with symptoms of both ADHD and bipolar, it is advisable to stabilize mood prior to addressing ADHD. One of our core values is to do no harm; unintentional harm may occur if I introduce a psychostimulant to a patient at risk for bipolar and in the process induce mania.
4. Describe the evidence-based medications and psychosocial treatments used in the management of children and adolescents with ADHD?
Stimulants are considered first-line treatment for ADHD (Boland et al., 2021; Gunter, 2013; Yearwood et al., 2012; Wetterer, 2020; Wolraich et al., 2019). They stimulate the brain, particularly the cortex to maintain focus and appropriate executive function (Boland et al., 2021; Gunter, 2013; NIMH, 2010; Wetterer, 2020; Wolraich et al., 2019; Yearwood et al., 2012). Non-stimulant options include atomoxetine (norepinephrine reuptake inhibitor) and guanfacine or clonidine (alpha-2 adrenergic agonists), which are considered second-line, and used for patients who may not tolerate psychostimulant medications, or if at risk of diversion and misuse of prescribed stimulants (Boland et al., 2021; Wolraich et al., 2019). A free list of the currently available, FDA-approved medications for ADHD is available online at www. ADHDMedicationGuide.com (Wolraich et al., 2019).
Psychosocial treatments include cognitive behavioral therapy (CBT), parent management training, classroom interventions, specialized educational programs, school-focused interventions such as tutoring support, untimed tests, and structured classroom environment (Boland et al., 2021; Rojas, 2012; Wetterer, 2020; Wolraich et al., 2019; Yearwood et al., 2012).
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