Chapter Nine
Summary
Approximately 3-7% of all school aged children have some form of attention deficit disorder. Additionally,
about 70% of these children will go on to demonstrate attention deficit into their adult years. Diagnosis can be
difficult as many children also have comorbid conduct, substance abuse, oppositional disorders, and bipolar illness.
Etiology appears to be linked to frontal lobe dysfunction and a dysregulation of the neurotransmitters
dopamine and norepinephrine. The basil ganglia, the amygdala, and possibly the reticular formation have also been
mentioned as areas of the brain that are affected by neurotransmitter dysregulation.
Diagnosis and treatment address both the neurological manifestations and the behavioral manifestations of
the disorder. First, a careful and thorough assessment must be conducted. This includes both a complete history and
physical examination, and an assessment with parents, teachers and others who observe the child or adult. The use of
psychological testing and rating instruments are often helpful along with the client’s own assessment of his/her level
of functioning.
Specific Discussion Questions:
1. What types of things should a therapist ask about or look for when a parent presents a child for an ADHD
assessment?
2. Why is counseling and psychotherapy necessary along with medication in the treatment of ADHD and other
related disorders?
3. What are some of the concerns expressed by parents when considering the treatment options for their children
with ADHD?
4. Are stimulants and other medications overused in treating ADHD?
5. What advantages do the long-acting stimulants have over the short-acting medications?
Possible True/False Questions:
1. Approximately 2-4% of all school aged children have an attention deficit.
2. As many as 70% of children with ADHD go on to demonstrate symptoms into their adult years.
3. As many as 50% of youth treated for substance abuse meet criteria for ADHD.
4. The neurotransmitter serotonin has been implicated in the etiology of ADHD.
5. MRI and other scans have shown that neurotransmitter irregularities in the frontal striatal networks and in the
cingulated gyrus may result in attention and learning disorders.
6. The Conner’s Rating Scales Revised is often used in the assessment of ADHD.
7. Typical side effects of stimulants include hypertension, insomnia, weight loss, and headaches.
8. Stratera along with other stimulants may be habit forming.
9. Concerta, Metadate ER and Ritalin SR are longer-acting, sustained release formulated stimulants.
10. Buproprion and disipramine are common antidepressants used in the treatment of ADHD.
11. ADHD is diagnosed much more often in boys than in girls.
12. ADHD remains one of the most treatable conditions in the DSM-IV.
Possible Multiple Choice Questions:
1. Approximately ____% of school aged children demonstrate an attention deficit?
a. 1-2%
b. 3-5 %
c. 3-7%
d. 8-10%
2. What percentage of ADHD youth will go on to demonstrate adult ADHD?
a. 40%
b. 50%
c. 60%
d. 70%
3. Irregularities of which neurotransmitter(s) has been implicated in ADHD?
a. Serotonin
b. Norepinephrine
c. Dopamine
d. both b and c
4. Which of the following stimulants offers once per day dosing?
a. Concerta
b. Ritalin
c. Cylert
d. Ritalin SR
5. Which stimulant uses a polymer, multi-particulate bead system?
a. Stratera
b. Ritalin SR
c. Tenex
d. none of these
6. Which of the following is not a stimulant per se, but rather an antidepressant with stimulant qualities?
a. Cylert
b. Ritalin
c. Stratera
d. Adderal
7. A typical dose of Adderall for a child is in the range of:
a. 5-10 mg per day
b. 5-15 mg per day
c. 5-30 mg per day
d. 30-60 mg per day
8. Insomnia, a common side-effect of stimulants, may be reduced by:
a. Using stimulants with shorter half-lives.
b. Using stimulants with longer half-lives.
c. Combining stimulants with sedatives.
d. None of the above.
9. Which drug for ADHD is less likely to be abused due to the nature in which it is metabolized?
a. Ritalin
b. Vyvanse
c. Focalin
d. None of these
10. For patients who cannot tolerate stimulants, Alpha-2 agonists such as ______ may be helpful.
a. Concerta
b. Daytrana
c. Intuniv
d. All of these
Alternative Class Assignments and Essay Questions:
1. Have students role play a session with a mother concerned about whether to use medications to treat her
ADHD son. What suggestions or parent education should be suggested?
2. You are working with an ADHD child who functions well during school hours, but fails to complete
homework and other duties after school hours when the medication wears-off. What suggestions could you
make to the parents and the prescribing professional?
3. You are working with Sally, a 29 year old bank executive with adult ADHD. She is functioning much better
since starting her antidepressants and Concerta, but complains of trouble sleeping. What treatment medication
suggestions could be discussed with her doctor?
4. Discuss the advantages and disadvantages of the various stimulant medications in the treatment of ADHD.
5. Explain the general etiology of ADHD and the areas of the brain that are most affected.
6. Explain how treating ADHD may in fact reduce the potential for substance abuse in ADHD patients.
Read the Case Vignette in this chapter and answer the following questions:
Case Vignette Discussion Questions:
1. What is the major pathology or diagnosis presented in the case?
2. Is there another disorder that may apply or should be ruled-out?
3. Do you agree with the medication suggestions made in this case?
4. Any other medications that might be considered…what is the rationale?
5. If you were asked to follow-up on this case as the treating therapist, would you offer any additional
suggestions or approaches?
Chapter Nine
Answer Key
True/False Questions:
Possible Multiple Choice Questions: