Assessment and Treatment of Childhood Problems: A Clinician's Guide

By Carolyn S. Schroeder; Betty N. Gordon | Go to book overview

CHAPTER 11
Attention-Deficit/
Hyperactivity Disorder
Attention-deficit/hyperactivity disorder (ADHD; American Psychiatric Association [APA], 1994) is the most commonly diagnosed behavioral disorder of childhood. Despite the dramatic increase in research over the past several decades and the progress made in the assessment, diagnosis, and treatment of children and adults with ADHD, there is still considerable controversy regarding this disorder. To address this controversy, the National Institutes of Health (NIH) held a consensus development conference in 1998 that brought experts in the field together to determine what is known about the disorder and provide hematicdations for future research (Jensen, 2000). The panelists at the conference reached a number of important points of concensus (NIH, 2000):
1. There is evidence that ADHD, as defined by the Diagnostic and Statistical Manual of Men- tal Disorders, fourth edition (DSM-IV), is a valid disorder. However, it remains unclear whether it should be conceptualized as the far end of a “normal” continuum (i.e., reflecting an extreme manisfestation of a set of temperamental characteristics), or whether it reflects a qualitatively different syndrome from “normal” behavior. It was also noted that the DSM-IV diagnostic criteria were designed for younger children and have not been adjusted for adolescents and adults.
2. Although evidence supports the hypothesis that ADHD symptomatology has a central nervous system basis (as do all normal and abnormal behaviors, thoughts, and emotions), such brain–behavior correlations do not constitute proof that ADHD reflects a disordered biological state. In effect, we still know little about the etiology of this disorder.
3. Evidence was presented that ADHD is a severe condition with lifelong personal and societal consequences for many individuals.
4. Although both medications (principally stimulants and tricyclics) and behavior therapies are effective treatments for ADHD, the preponderance of evidence indicates that medications are somewhat more effective. Combined behavioral and pharmacological treatments may offer some modest advantages over medication alone. Furthermore, there is no conclusive evidence that careful therapeutic use of medications is harmful, and the committee refuted the notion that current levels of use of stimulants have had a substantial effect on drug abuse among high school students.
5. There are widely varying, inconsistent, and sometimes poor-quality assessment, treatment, and follow-up practices in the “real” world, probably leading to both over- and under

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Assessment and Treatment of Childhood Problems: A Clinician's Guide
Table of contents

Table of contents

  • Title Page iii
  • About the Authors vii
  • Preface ix
  • Contents xiii
  • Part I - The Foundation 1
  • Chapter 1 - Development of Psychopathology 3
  • Chapter 2 - Assessment to Intervention 40
  • Part II - Managing Common Problems 79
  • Chapter 3 - Eating Problems 81
  • Chapter 4 - Toileting: Training, Enuresis, and Encopresis 115
  • Chapter 5 - Habits and Tics 159
  • Chapter 6 - Sleep 186
  • Chapter 7 - Sexuality and Sexual Problems 217
  • Chapter 8 - Fears and Anxieties 262
  • Chapter 9 - Depression 302
  • Chapter 10 - Disruptive Behavior 331
  • Chapter 11 - Attention-Deficit/Hyperactivity Disorder 377
  • Part III - Managing Stressful Life Events 417
  • Chapter 12 - Siblings 419
  • Chapter 13 - Divorce 440
  • Chapter 14 - Bereavement 466
  • Appendix A - Description of Assessment Instruments 487
  • Appendix B - Assessment Instruments 505
  • References 541
  • Index 615
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