Bipolar Disorder and ADHD: Diagnosis and Treatment Issues
by David Gottlieb, Ph.D., and Thomas Shoaf, M.D
Bipolar disorder and ADHD can occur together in children, but the dual disorder is difficult to diagnose and treat. One of the problems is making an accurate diagnosis. Clinicians have not yet agreed on the criteria that are primary in mania in pre-adolescent children. One aim of this article is to propose a tentative classification scheme for pediatric mania. Subsequently, the authors explain why it is important to determine whether these children have characteristics of ADHD as well. After looking at diagnostic issues, the authors outline treatment strategies, both medical and psychological, for bipolar disorder when it occurs along with ADHD. Treatment of bipolar disorder in children is still in its infancy, and treatment of the dual diagnosis with ADHD is even newer. The dual diagnosis is difficult to treat and requires a team approach: the psychiatrist, psychologist, teachers, and parents need to communicate with each other and work together to help these children develop self-control. READ MORE.....................

Identifying New Symptoms for Diagnosing ADHD in Adulthood
by Russell A. Barkley, Ph.D and Kevin Murphy, Ph.D.
The current symptom list for ADHD in the DSM-IV (American Psychiatric Association, 2000) was developed on children and was only field tested using children (Lahey, Applegate, McBurnett, Biederman, Greenhill et al., 1994; Spitzer, Barkley, & Davies, 1989). The utility of extending that list to adults with ADHD is therefore an open question. This article addresses the important issue of whether or not better symptoms could be identified for the adult stage of this disorder than those 18 childhood symptoms currently represented in the DSM-IV. We began by making a list of the most common complaints that we had heard from adults presenting at the Adult ADHD clinic at the University of Massachusetts Medical Center where more than 100 adults were evaluated each year. We also went back through previous charts of adults seen at this clinic to identify such symptom items. We also used the theory of executive functioning developed by Barkley (1997) and extended to understanding ADHD in order to generate potential symptoms that deal with each of the five executive components of his model: response inhibition, nonverbal working memory and sense of time, verbal working memory, emotional/motivation self-regulation, and planning (generativity or reconstitution). The results of our work on this new symptom list will appear early next year in a new book presenting the results of an original research project (Barkley & Murphy, 2007). This project constitutes one of the most comprehensive evaluations of adults with ADHD. In this project, we extensively evaluated 146 adults with ADHD on numerous measures of adaptive functioning across many domains of major life activities. We compared them to both a community control group of 109 adults and a clinical control group of 97 adults seen at the same ADHD Clinic but not diagnosed with the disorder. These adults had a mean age of 32-37 years, depending on the group, with 47-68% of each group being male READ MORE...................

ADHD Symptoms vs Impairment: Revisited
by Russell A. Barkley, Ph.D., Charles E. Cunningham, Ph.D., Michael Gordon, Ph.D., Stephen V. Faraone, Ph.D., Larry Lewandowski, Ph.D., and Kevin R. Murphy, Ph.D.
This article takes up where our previous article left off (Gordon et al., 2005, The ADHD Report , 13(4), p. 1-9) concerning the relationship of severity of ADHD symptoms to degree of impairment in major life activities. It expands upon and extends our earlier work while also qualifying some of our previous conclusions. It examines this relationship and the determination of impairment from several additional methods and perspectives and using several additional large databases in addition to re-analyzing data from two of those used in the earlier paper. Our earlier article examined the relationship of severity of ADHD symptoms, variously measured, to each of a number of specific and discrete measures of impairment. It found that ADHD symptoms showed low to moderate relationships (correlations) with each of those specific measures of impairment. The correlations ranged in magnitude from .01 to .65, but mostly fell in the .10 to .30 range. At most, the overlapping variance between symptoms and any specific measure of impairment was around 42% ( r = .65), most falling at or below 10% ( r < .32). Inattention symptoms were most strongly related to specific measures of educational impairment. We concluded that symptoms and impairment were somewhat distinct dimensions that should be considered as such in the diagnostic process. We further READ MORE....................

National Institute of Mental Health Multimodal Treatment Study of Children with AD/HD
The National Institute of Mental Health (NIMH) will join Columbia University to present the results of the collaborative NIMH Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder (MTA). The press conference will be held on December 14, 1999 at 10:00 A.M. at the Columbia University College of Physicians and Surgeons, Conference Center, Columbia Presbyterian, East Side, 16 East 60 th Street, New York City. Two papers detailing the results of the MTA study will be published in the December issue of the American Medical Association's Archives of General Psychiatry. (Citation: Archives of General Psychiatry 56(12): 1073-86, 1999). READ MORE....................

Brain Imaging in Children with AD/HD
A 10-year study by National Institute of Mental Health (NIMH) scientists has found that brains of children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD) are 3-4 percent smaller than those of children who don't have the disorder - and that medication treatment is not the cause. Indeed, in this first major study to scan previously never-medicated patients, they found "strikingly smaller" white matter volumes in children who had not taken stimulant drugs. Still, the course of brain development in the ADHD patients paralleled that of normal subjects, suggesting that whatever caused the disorder happened earlier. READ MORE....................

Practice Parameters for the Assessment and Treatment of Children, Adolescents, and Adults with Attention-Deficit/Hyperactivity Disorder
This summary by the American Academy of Child and Adolescent Psychiatry of the practice parameters describes the assessment, differential diagnosis, and treatment of children, adolescents, and adults who present with symptoms of attention-deficit/hyperactivity disorder. The rationales for specfic recommendations are based on a review of the scientific literature and clinical consensus which is contained in the complete document. Assessment includes clinical interviews with the child and parents and standardized rating scales from parent and teachers. Testing of intelligence and academic achievement is usually required. Comorbidity is common. The cornerstones of treatment are support and education of parents, appropriate school placement, and psychopharmacology. (Citation: Journal of the American Academy of Child and Adolescent Psychiatry 36(10 Suppl): 69S-84S, 1997). READ MORE....................

Practice Parameter for the Use of Stimulant Medications in the Treatment of Children, Adolescents, and Adults
This practice parameter by the American Adademy of Child and Adolescent Psychiatry describes treatment with stimulant medication. It uses an evidence-based medicine approach derived from a detailed literature review and expert consultation. Stimulant medications in clinical use include methylphenidate, dextroamphetamine, mixed salts amphetamine, and pemoline. It carries FDA indications for treatment of attention-deficit/hyperactivity disorder and narcolepsy. (Citation: Journal of the American Academy of Child and Adolescent Psychiatry 41(2 Suppl): 26S-49S, 2002). READ MORE..................

Adult AD/HD: Evaluation and Treatment in Family Medicine by H. Russell Searight, Ph.D. John M. Burke, Pharm.D. and Fred Rottnek, MD
Attention-deficit/hyperactivity disorder (ADHD) affects 30 to 50 percent of adults who had ADHD in childhood. Accurate diagnosis of ADHD in adults is challenging and requires attention toearly development and symptoms of inattention, distractibility, impulsivity and emotional lability. Diagnosis is further complicated by the overlap between the symptoms of adult ADHD and the symptoms of other common psychiatric conditions such as depression and substance abuse. While stimulants are a common treatment for adult patients with ADHD, antidepressants may also be effective. Cognitive-behavioral skills training and psychotherapy are useful adjuncts to pharmacotherapy. (Citation: Am Fam Physician 2000;62:2077-86,2091-2.) READ MORE...............

CDC's National Center on Birth Defects and Developmental Disabilities Announces Opening of CHADD's National Resource Center
Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common childhood behavioral disorders and can persist through adolescence and into adulthood. The causes are currently unknown. Parents and others who are searching for information on Attention-Deficit/Hyperactivity Disorder now have somewhere to turn. May 20 was the official opening of the Children and Adults with Attention-Deficit/Hyperactivity Disorder’s (CHADD) National Resource Center (NRC) on AD/HD, the country’s first and only national clearinghouse dedicated to the evidence-based science and treatment of AD/HD. The clearinghouse is a collaboration between the CDC and CHADD, an advocacy organization serving individuals with AD/HD. READ MORE....................

Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder in School-Age Children
This report by the Council of Scientific Affairs of the American Medical Association examines the issue of the increasing number of diagnoses of attention deficit hyperactivity disorder (ADHD) and addresses public concerns regarding possible overprescription of ADHD medications. The report reviews the diagnosis and treatment of ADHD as well as the epidemiologic literature pertaining to ADHD prevalence and prescribing patterns. (Citation: Journal of the American Medical Association 279(14): 1100-1107, 1998). READ MORE ....................

Promising Practices for Students with ADHD by Harvey C. Parker, Ph.D.
ADHD is a neurologically-based disorder which affects one.s ability to regulate behavior and attention. People with ADHD often have problems sustaining attention, controlling activity, and managing impulses. Although we can easily regulate many things in our environment, regulating ourselves is not always so simple. Unfortunately, the process of self-regulationÑpurposefully controlling behaviorÑis rather complicated. The brain is responsible for self-regulation-planning, organizing, and carrying out complex behavior. These are called "executive functions." READ MORE..................................

ADHD Medication Chart by Harvery C. Parker, Ph.D. and Dorothy Johnson, M.D.
This chart was updated 4/14/04.
Treatment of ADHD usually includes medical management, behavior modification. counseling, and school or work accommodations. The medications charted above include: (1) the stimulants, (2) the non-stimulant Strattera (atomoxetine) with effects similar to stimulants, (3) the antidepressant Wellbutrin (bupropion) and (4) two antihypertensives Catapres (clonidine) and Tenex (guanfacine). Stimulants include all formulations of methyphenidate (Ritalin, Focalin, Metadate and Methylin) and all forms of amphetamines (Dexedrine, Dextrostat and Adderall). Individuals respond in their own unique way to medication depending upon their physical make-up, severity of symptoms. associated conditions, and other factors. Careful monitoring should be done by a physician in collaboration with the teacher, therapist. parents, spouse, and patient. Medications to treat ADHD and related conditions should only be prescribed by a physician. Information presented here is not intended to replace the advice of a physician. .READ MORE.............................

International Consensus Statement on ADHD by Russell A. Barkely, Ph.D. and others.
We, the undersigned consortium of international scientists, are deeply concerned about the periodic inaccurate portrayal of attention deficit hyperactivity disorder (ADHD) in media reports. This is a disorder with which we are all very familiar and toward which many of us have dedicated scientific studies if not entire careers. We fear that inaccurate stories rendering ADHD as myth, fraud, or benign condition may cause thousands of sufferers not to seek treatment for their disorder. It also leaves the public with a general sense that this disorder is not valid or real or consists of a rather trivial affliction.READ MORE.....................................

Accommodations Help Students with Attention Deficit Hyperactivity Disorder by Harvey C. Parker, Ph.D.
Children and youth with attention deficit disorder (ADHD) often have serious problems in school. Inattention, impulsiveness, hyperactivity, disorganization, and other difficulties can lead to unfinished assignments, careless errors, and behavior which is disruptive to one's self and others. Through the implementation of relatively simple and straightforward accommodations to the classroom environment or teaching style, teachers can adapt to the strengths and weaknesses of students with ADD. Small changes in how a teacher approaches the student with ADD or in what the teacher expects can .READ MORE.........................

Assessment of Attention Deficit Hyperactivity Disorder: A Team Approach by Harvey C. Parker, Ph.D.
The primary characteristics of Attention Deficit Hyperactivity Disorder (ADHD/ADD) are not difficult to spot in a classroom. However, not all children who are inattentive, impulsive, or overactive have ADD. These same symptoms can be a result of other factors such as: frustration with difficult schoolwork, lack of motivation, emotional concerns, or other medical conditions. A comprehensive assessment by a team of professionals working in conjunction with the parents and the child can usually determine whether problems are the result of ADD or other factors. Members of this READ MORE ...............................

Overcoming Underachieving: Understanding Children's School Problems by Sam Goldstein, Ph.D.
School problems of children usually cannot be resolved quickly or cured with a magic potion. Instead they are often chronic and require regular management. To be effective, however, parents and teachers must first understand how children learn. What skills are required for school success? How do strengths or weaknesses in particular skills affect a child’s mastery of particular subjects? Often the reasons a child struggles at school may be very different from the reasons another child struggles. It is important, however, to take the time to understand the underlying factors that .READ MORE.............................

How to Know if Your Child is Depres ssed and What to Do by Barbara Ingersoll, Ph.D. and Sam Goldstein, Ph.D.
Three year old Joshua was a happy, outgoing youngster who enjoyed a great deal of attention from a large, loving family. He became increasingly withdrawn, irritable, and unhappy following a three-week hospitalization for an acute physical illness.
Despite a history of mild learning disabilities and Attention Deficit Disorder, eight year old Lee appeared to be doing well at home and in school. When his best friend moved away he became morose and moody. He lost interest in his school work, his appetite diminished, and he spent long hours sleeping or watching television. At age twelve, Elizabeth .READ MORE........................

Conroversial Treatments for Children with Attention Deficit Hyperactivity Disorder by Sam Goldstein, Ph.D. and Barbara Ingersoll, Ph.D.
In the past decade there has been a tremendous upsurge of scientific and public interest in Attention-deficit Hyperactivity Disorder (ADHD). The interest is reflected not only in the number of scientific articles but in the explosion of books for parents and teachers. Great strides have been made in understanding and managing this common childhood disorder. Children with ADHD who would have gone unrecognized and untreated only a few short years ago are now being helped, often .READ MORE............................