ADHD in Children and Adolescents

Transcription

1 Workbook for ADHD in Children and Adolescents Workbook By Julie Guillemin, MSW, LICSW Upon successful completion of this course, continuing education hours will be awarded as follows: Social Workers, Counselors, Marriage and Family Therapists, Psychologists: 4 Clock Hours

2 WESTERN SCHOOLS P.O. Box 1930 Brockton, MA About the WORKBOOK author Julie Guillemin, MSW, LICSW, earned her MSW in 2000 from the Boston University School of Social Work. For more than 15 years, Ms. Guillemin has worked with toddlers, children, and adolescents and their families in private and public school settings, providing individual and group therapy and social skills instruction. She is currently in private practice at Levin & Zangrillo, P.C., in Hingham, Massachusetts, where she works with children, adolescents, adults, and families to address adjustment problems, psychiatric disorders, behavioral issues, and learning disabilities. She has extensive experience working with individuals with ADHD. Ms. Guillemin collaborates with pediatricians, teachers, and other service providers to enhance the treatment experience of children and adolescents with ADHD and other disorders. She is both a licensed independent clinical social worker and a licensed school social worker/school adjustment counselor in the Commonwealth of Massachusetts. Julie Guillemin has disclosed that she has no significant financial or other conflicts of interest pertaining to this course book. Behavioral Health Planner: Lys Hunt, MSW, LICSW The planner who worked on this continuing education activity has disclosed that she has no significant financial or other conflicts of interest pertaining to this course book. Copy Editor: Diane Hinckley Western Schools courses are designed to provide healthcare professionals with the educational information they need to enhance their career development as well as to work collaboratively on improving patient care. The information provided within these course materials is the result of research and consultation with prominent healthcare authorities and is, to the best of our knowledge, current and accurate at the time of printing. However, course materials are provided with the understanding that Western Schools is not engaged in offering legal, medical, or other professional advice. Western Schools courses and course materials are not meant to act as a substitute for seeking professional advice or conducting individual research. When the information provided in course materials is applied to individual cases, all recommendations must be considered in light of each case s unique circumstances. Western Schools course materials are intended solely for your use and not for the purpose of providing advice or recommendations to third parties. Western Schools absolves itself of any responsibility for adverse consequences resulting from the failure to seek medical, or other professional advice. Western Schools further absolves itself of any responsibility for updating or revising any programs or publications presented, published, distributed, or sponsored by Western Schools unless otherwise agreed to as part of an individual purchase contract. Products (including brand names) mentioned or pictured in Western Schools courses are not endorsed by Western Schools, any of its accrediting organizations, or any state licensing board. ISBN: COPYRIGHT 2016 Western Schools. All Rights Reserved. No part(s) of this material may be reprinted, reproduced, transmitted, stored in a retrieval system, or otherwise utilized, in any form or by any means electronic or mechanical, including photocopying or recording, now existing or hereinafter invented, nor may any part of this course be used for teaching without written permission from the publisher. FP0516WS ii

3 COURSE INSTRUCTIONS IMPORTANT: Read these instructions BEFORE proceeding! HOW TO EARN CONTINUING EDUCATION CREDIT To successfully complete this course you must: 1) Read the entire course 2) Pass the final exam with a score of 75% or higher* 3) Complete the course evaluation *You have three attempts to pass the exam. If you take the exam online, and fail to receive a passing grade, select Retake Exam. If you submit the exam by mail or fax and you fail to receive a passing grade, you will be notified by mail and receive an additional answer sheet. Final exams must be received at Western Schools before the Complete By date located at the top of the FasTrax answer sheet enclosed with your course. Note: The Complete By date is either 1 year from the date of purchase, or the expiration date assigned to the course, whichever date comes first. HOW TO SUBMIT THE FINAL EXAM AND COURSE EVALUATION ONLINE: best option! For instant grading, regardless of course format purchased, submit your exam online at Benefits of submitting exam answers online: Save time and postage Access grade results instantly and retake the exam immediately, if needed Identify and review questions answered incorrectly Access certificate of completion instantly Note: If you have not yet registered on Western Schools website, you will need to register and then call customer service at to request your courses be made available to you online. Mail or Fax: To submit your exam and evaluation answers by mail or fax, fill out the FasTrax answer sheet, which is preprinted with your name, address, and course title. If you are completing more than one course, be sure to record your answers on the correct corresponding answer sheet. Complete the FasTrax Answer Sheet using blue or black ink only. If you make an error use correction fluid. If the exam has fewer than 100 questions, leave any remaining answer circles blank. Respond to the evaluation questions under the heading Evaluation, found on the right-hand side of the FasTrax answer sheet. See the FasTrax Exam Grading & Certificate Issue Options enclosed with your course order for further instructions. CHANGE OF ADDRESS? Contact our customer service department at , or customerservice@westernschools.com, if your postal or address changes prior to completing this course. WESTERN SCHOOLS GUARANTEES YOUR SATISFACTION If any continuing education course fails to meet your expectations, or if you are not satisfied for any reason, you may return the course materials for an exchange or a refund (excluding shipping and handling) within 30 days, provided that you have not already received continuing education credit for the course. Software, video, and audio courses must be returned unopened. Textbooks must not be written in or marked up in any other way. Thank you for using Western Schools to fulfill your continuing education needs! WESTERN SCHOOLS P.O. Box 1930, Brockton, MA iii

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5 Western Schools course evaluation ADHD in Children and Adolescents INSTRUCTIONS: Using the scale below, please respond to the following evaluation statements. All responses should be recorded in the right-hand column of the FasTrax answer sheet, in the section marked Evaluation. Be sure to fill in each corresponding answer circle completely using blue or black ink. Leave any remaining answer circles blank. A B C D Agree Agree Disagree Disagree Strongly Somewhat Somewhat Strongly OBJECTIVES: After completing this course, I am able to: 1. Explain the symptoms, epidemiology, and differential diagnosis of ADHD in children and adolescents. 2. Describe theories and models of ADHD in children and adolescents. 3. Identify issues involved in assessing and diagnosing ADHD in children and adolescents. 4. Differentiate treatment methods and treatment challenges for youth with ADHD. 5. Analyze case studies of youth diagnosed with and treated for ADHD. COURSE CONTENT 6. The course content was presented in a well-organized and clearly written manner. 7. The course content was presented in a fair, unbiased and balanced manner. 8. The course content presented current developments in the field. 9. The course was relevant to my professional practice or interests. 10. The course material was appropriate to my education, experience, and licensure level. 11. The course expanded my knowledge and enhanced my skills related to the subject matter. 12. I intend to apply the knowledge and skills I ve learned to my practice. A. Yes B. Unsure C. No D. Not Applicable CUSTOMER SERVICE The following section addresses your experience in interacting with Western Schools. Use the scale below to respond to the statements in this section. A. Yes B. No C. Not Applicable 13. Western Schools staff was responsive to my request for disability accommodations. 14. The Western Schools website was informative and easy to navigate. 15. The process of ordering was easy and efficient. 16. Western Schools staff was knowledgeable and helpful in addressing my questions or problems. ATTESTATION 17. I certify that I have read the course materials and personally completed the final examination based on the material presented. Mark A for Agree and B for Disagree. v continued on next page

6 vi Course Evaluation ADHD in Children and Adolescents COURSE RATING 18. My overall rating for this course is A. Poor B. Below Average C. Average D. Good E. Excellent 19. Choose the response that best represents the total number of clock hours it took you to complete this course. A. 3-5 Hours B. More than 5 hours C. Less than 3 hours 20. How much did you learn as a result of this CE program? 1 (A) 2 (B) 3 (C) 4 (D) 5 (E) Very Little Great Deal 21. How useful was the content of this CE program for your practice or other professional development? 1 (A) 2 (B) 3 (C) 4 (D) 5 (E) Not Useful Extremely Useful You may be contacted within 3 to 6 months of completing this course to participate in a brief survey to evaluate the impact of this course on your clinical practice and patient/client outcomes. Note: To provide additional feedback regarding this course, Western Schools services, or to suggest new course topics, use the space provided on the Important Information form found on the back of the FasTrax instruction sheet included with your course.

7 CONTENTS Evaluation...v Pretest...ix Introduction...xi Lesson Plan...1 Final Exam...3 vii

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9 PRETEST 1. Begin this course by taking the pretest. Circle the answers to the questions on this page, or write the answers on a separate sheet of paper. Do not log answers to the pretest questions on the FasTrax test sheet included with the course. 2. Compare your answers to the answers in the pretest key located at the end of the pretest. The pretest key indicates the page where the content of that question is discussed within the textbook. Make note of the questions you missed, so that you can focus on those areas as you complete the course. 3. Read the entire course and complete the exam questions at the end of the course. Answers to the exam questions should be logged on the FasTrax test sheet included with the course. Note: Choose the one option that BEST answers each question. 1. Children and adolescents with ADHD a. rarely meet the criteria for ADHD in adulthood. b. are at risk for negative psychosocial and emotional outcomes. c. typically resolve symptoms permanently through treatment. d. usually have significant learning disabilities that impair academic functioning. 3. When assessing for ADHD in children and adolescents, clinicians should remember that a. information on client functioning in multiple settings is essential. b. genetic testing is the simplest and most reliable source of information. c. the developmental stage of the client is irrelevant. d. there are few reliable behavioral rating scales to use. 2. ADHD is often challenging to diagnose in children and adolescents because of the a. frequent overlap of ADHD symptoms with symptoms of comorbid conditions. b. lack of tools to assess ADHD in juveniles. c. unreliability of children and adolescents when reporting symptoms. d. unwillingness of clinicians to assess for ADHD. PRETEST KEY 1. B Page 6 2. A Page 7 3. a Page d Page c Page 33 & 62 ix 4. The most successful treatment for ADHD in children and adolescents involves a. nonstimulant medications. b. interventions in the home. c. group psychotherapy. d. medication and psychotherapy. 5. Tools and resources for diagnosing and treating ADHD in children and adolescents a. are prohibitively expensive. b. are available only through schools. c. include support groups, behavior rating scales, and toolkits. d. must be recommended by pediatricians and psychiatrists.

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11 INTRODUCTION Course Objectives After completing this course, the learner will be able to: 1. Explain the symptoms, epidemiology, and differential diagnosis of ADHD in children and adolescents. 2. Describe theories and models of ADHD in children and adolescents. 3. Identify issues involved in assessing and diagnosing ADHD in children and adolescents. 4. Differentiate treatment methods and treatment challenges for youth with ADHD. 5. Analyze case studies of youth diagnosed with and treated for ADHD. Attention-deficit/hyperactivity disorder (ADHD) is a chronic neurodevelopmental disorder that emerges in childhood, persists throughout the life span, and impairs functioning in multiple domains. ADHD affects social, emotional, and academic functioning of individuals and puts children and adolescents at risk for psychosocial problems. Symptoms of the disorder can be disabling, making it difficult to succeed academically and socially and often causing emotional distress. Diagnosing ADHD is complicated by the fact that symptoms of ADHD are similar to symptoms of many distinct psychiatric, medical, developmental, and neurological disorders. Additionally, comorbidity rates are high for individuals with ADHD. Behavioral manifestations of ADHD in early childhood will differ from those in latency age or adolescence; clinicians need to use developmentally appropriate assessment tools in order to distinguish ADHD symptoms from normal developmental challenges. Cultural considerations are also relevant and must be considered in assessment, diagnosis, and treatment approaches. Treatment options for ADHD include medication, individual and family psychotherapy, social skills training, and alternative treatments. Medications for ADHD are often effective but may have problematic side effects, including worsening comorbid disorders. Treatment compliance is particularly challenging with children and adolescents, especially when family or school staff are resistant to having the child receive treatment. This course offers social workers, mental health counselors, marriage and family therapists, and psychologists information that will assist them in assessing, diagnosing, and treating adolescents and children with ADHD. Diagnostic criteria are drawn from the DSM-5 and aligned to ICD-10 codes. A review of the different theories and models of ADHD provides the clinician with an understanding of environmental influences, genetic contributions, neurological issues, and psychological factors in ADHD. The essential components of assessing and diagnosing ADHD, including psychological and achievement testing, client history, and environmental and family influence, are discussed. Symptoms manifested by children and adolescents of different ages are presented. Diagnosis is explained, including the complexities involved in differential diagnosis and assessing for comorbid conditions. Methods of xi

12 xii Introduction ADHD in Children and Adolescents treatment are explored, including psychopharmacology, psychotherapy, and treatments in combination. Research on treatment effects with children and adolescents is presented, allowing the clinician to select appropriate, evidence-based treatments that can be tailored to individual clients. Issues encountered in treating children, adolescents, and their families are examined. The text presents case vignettes to help learners apply the knowledge gained from the text. In addition, toolkits and rating scales are recommended for use with juveniles and their families. The text also identifies and describes support groups and organizations, along with their contact information. This intermediate-level course is an ideal reference for clinicians who encounter ADHD in child and adolescent clients in all settings including schools, hospitals, and mental health treatment centers. The course provides clinicians with a comprehensive resource that assists in understanding, assessing, diagnosing, and treating ADHD in children and adolescents.

13 lesson plan ADHD in Children and Adolescents This educational offering incorporates the information contained in ADHD in Children and Adolescents by Brian P. Daly, Aimee K. Hildenbrand, and Ronald T. Brown, into an integrated learning experience. Learning objectives for the course focus individual study on information contained within the textbook. The final examination questions are based on the course objectives and are intended to evaluate the reader s learning of each objective. To complete this course, read the Table of Contents located in the front of the textbook to determine the scope of the content. Review the course objectives, then read each chapter in the textbook and answer the final examination questions (workbook pages 3-6) as indicated in this Lesson Plan. Answer final exam questions online at for instant results, or log answers on the FasTrax answer sheet provided with the course. NOTE: Before getting started, log into your account at com/my-courses to take your exam as you read the course. You can save your progress and return to it at any time. If completing by mail or fax, please be sure you are using the FasTrax answer sheet labeled ADHD in Children and Adolescents. Chapter 1: Description Chapter 1 offers an overview of the symptoms and epidemiology of attention-deficit/ hyperactivity disorder (ADHD) in children and adolescents. The authors discuss prevalence, age of onset, presentation, and differential diagnosis issues. Read and study Chapter 1 and answer questions 1-7. Chapter 2: Theories and Models of ADHD in Children and Adolescents In Chapter 2, the authors explain the theories and models of ADHD and explore the contributions of genetic and neurological factors, environmental factors, and psychosocial factors. The content of Chapter 2 addresses the physiological differences between people with and without ADHD, and discusses neurological studies that illuminate how ADHD affects cognitive functioning. Read and study Chapter 2 and answer questions Chapter 3: Diagnosis and Treatment Indications Chapter 3 explores the assessment and diagnosis of ADHD. The authors offer guidance on gathering relevant information about the client s history, level of functioning in different settings, 1

14 Lesson Plan 2 ADHD in Children and Adolescents and social and emotional issues. The intricacies of differential diagnosis are discussed. The authors present practical advice on obtaining the most accurate information and test results. Read and study Chapter 3 and answer questions Chapter 4: Treatment Chapter 4 focuses upon treatment methods for ADHD, including research findings and statistical data on the effectiveness of different treatments. Psychopharmacological treatments, including stimulants and nonstimulants, are explored in depth. Dual diagnosis and comorbid conditions are explained as they relate to treatment planning. The authors describe psychoeducation, cognitive behavioral therapy, and behavior therapy and family interventions, and offer guidelines on how to plan and use these treatments. The authors also explore issues that can impede treatment. Educational interventions and school accommodations are described and compared. Read and study Chapter 4 and answer questions Chapter 5: Case Vignettes Chapter 5 presents case studies of individuals with ADHD. Diagnosis and treatment planning are explored. Read and study Chapter 5 and answer questions

15 Final Exam ADHD in Children and Adolescents Questions 1-25 Note: Choose the one option that BEST answers each question. 1. In order for ADHD to be diagnosed using the DSM-5, symptoms must a. be present for at least one year. b. have been in remission at some point. c. manifest as psychotic behavior. d. interfere with academic, social, or occupational functioning. 2. ADHD is a commonly diagnosed disorder affecting school-aged children. The prevalence of ADHD in school-aged children is a. 3%-10%. b %. c. 33%-40%. d. greater than 45%. 3. Differential diagnosis of ADHD is challenging because a. it most often mimics obsessive compulsive disorder. b. many symptoms of ADHD are similar to those in other psychiatric disorders. c. symptoms of other disorders present earlier in a child s development than ADHD. d. multiple informant rating scales and interviews can be used. 4. Disorders that are comorbid with ADHD are a. rare in children and adolescents with ADHD. b. much fewer in adolescence than in childhood. c. most frequently disruptive disorders. d. most frequently autism spectrum disorders. 5. Recommendations from the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry include a. conducting a comprehensive interview with the client and caregivers as the first step. b. interviewing teachers rather than caregivers if the presenting problems occur primarily at school. c. using behavior scales developed by practitioners for individual clients. d. using a single measure across settings in order to simplify the process. 3 continued on next page

16 Final Exam 4 ADHD in Children and Adolescents 6. The dimensional approach to assessing for ADHD a. relies solely on determining the absence or presence of hyperactive behaviors in order to make a diagnosis. b. evaluates client symptoms along a continuum and compares them to chronologically same-aged peers. c. allows for an ADHD diagnosis even if presenting symptoms do not cause any impairment in functioning. d. recommends against the use of observations and behavior scales. 7. Neuropsychological testing is recommended a. in order to predict how a patient will respond to medication. b. only for assessing executive function. c. to assess multiple domains of cognitive functioning. d. to determine if a child s parents are also diagnosed with ADHD. 8. Studies on the role of genetics in ADHD have shown that ADHD is a. one of the most heritable psychiatric disorders. b. caused by one specific gene. c. one of the least heritable psychiatric disorders. d. caused by a deficit of serotonin. 9. Neurological differences between children with ADHD and children without ADHD 10. Russell Barkley s model of ADHD asserts that a. the main deficits of ADHD are in behavioral inhibition and self-awareness. b. impaired problem solving is the most disabling aspect of ADHD. c. emotional, not neurocognitive, differences characterize the disorder. d. providing positive reinforcement is the only effective method of treating ADHD. 11. Research findings consistently suggest that the factors contributing to ADHD are a. primarily maternal substance abuse and stress. b. entirely genetic. c. neurobiological, environmental, and genetic. d. mainly psychosocial. 12. When children are referred for diagnosis and treatment of ADHD prior to age 6, a. the differential diagnosis is much easier than at later ages. b. clinicians must assess the degree of interference from behaviors that may otherwise seem age appropriate with social functioning and learning. c. it is solely because inattention is interfering with increased academic responsibilities and challenges. d. they are less likely to develop comorbid disorders. a. are caused by stimulant medications. b. typically resolve by late adolescence. c. include a larger corpus callosum in children and adolescents with ADHD. d. include abnormal functioning of the default-mode network in children with ADHD.

17 Final Exam ADHD in Children and Adolescents To gather useful information about a young client s array of symptoms, clinicians should a. rely on observations made during a single structured office visit. b. interview clients in environments that are free of distractions. c. make the teacher behavior rating scale the primary source of information. d. observe clients at home or at school. 14. The data gathered from neuropsychological testing in the assessment of ADHD a. yields more biased information than behavioral rating scales. b. lacks performance-based information. c. is used to evaluate ADHD symptoms only in social domains. d. identifies executive functioning factors that contribute to ADHD symptoms. 15. When a child or adolescent assessed for ADHD displays only 5 symptoms of inattention or hyperactivity/impulsivity, he or she a. should be considered completely unaffected by ADHD. b. may still experience difficulties in social and academic functioning that may benefit from intervention. c. should only be evaluated again once 18 months have passed. d. is at the same level of risk as other children without symptoms of ADHD, and no further support is warranted. 16. Surprisingly, research findings on the effects of stimulant medication on children and adolescents with ADHD indicate that a. stimulant medication does not dramatically improve academic performance. b. stimulant medication along with parent training resolves all academic problems. c. clients who have a positive response to medication experience recovery and no longer need medication after 6 months of treatment. d. clients who are treated with medication are at a much greater risk for schizophrenia and other psychotic disorders. 17. Adolescents who are diagnosed with ADHD should be prescribed a. nonstimulant medication only. b. short-acting forms of medication only. c. stimulant medications after being evaluated for a substance use disorder. d. stimulant medications immediately to quickly mediate risk for substance abuse. 18. Children who take medication for ADHD a. should not take medication for other psychiatric disorders. b. should initially be monitored for effects by the prescriber weekly, then monthly. c. may take a maximum of 2 doses of stimulant daily. d. typically experience 2-4 hours of symptom control from long-acting stimulants.

18 Final Exam 6 ADHD in Children and Adolescents 19. The efficacy of behavioral therapy for children with ADHD a. is less than psychosocial therapy for children with ADHD. b. depends upon attachment theory and neurofeedback. c. is easily generalized from the therapist s office to the child s home and school. d. is highest when implemented with the client, parents, and teachers. 20. According to the U.S. IDEA and the U.S. Rehabilitation Act of 1973, a child or adolescent diagnosed with ADHD is a. always entitled to an Individual Education Plan (IEP). b. not considered disabled under federal law. c. possibly eligible for an IEP or 504 plan if his or her learning is affected. d. automatically considered to have a functional learning disability. 21. Research findings indicate that multimodal treatment (e.g., medication and behavior training) for ADHD a. yields the best short-term treatment response compared to one treatment alone. b. is never recommended for individuals under the age of 13 years old. c. results in complete symptom remission and sustained behaviors for all clients. d. is recommended only when a mood disorder is comorbid with ADHD. 22. One reason for poor treatment adherence among children with ADHD is a. caregivers beliefs that ADHD is a neurodevelopmental disorder. b. caregivers beliefs that ADHD symptoms are temperamental or stress-related. c. that medication is usually ineffective. d. the lack of effective therapy options. 23. In Case 5.1, an assessment of a preschoolaged child concludes with a a. diagnosis of ADHD based on the presence of symptoms and impairment at home and at school. b. recommendation for a neuropsychological evaluation for an in-depth assessment of Lakisha s executive functioning. c. determination that the child is at risk for ADHD, rather than a diagnosis of ADHD. d. a referral for a medication evaluation because of the child s age. 24. In Case 5.2, the school-aged child is a. diagnosed with ADHD based solely on his extensive learning disabilities. b. referred for assessment because of poor social skills and behavior problems at school. c. unlikely to have ADHD because he is aggressive at home, not at school. d. likely to have the best outcome due to the combination of treatment modalities. 25. The adolescent in Case 5.3 was diagnosed with ADHD in high school a. due to his inability to compensate for his symptoms as he had done in earlier years. b. using only subjective behavior scales. c. after struggling academically and socially for most of his school career. d. and is more likely to benefit from stimulant medication because he is hyperactive. This concludes the final examination. Please answer the evaluation questions found on page v of this course book.