CURRENT DIRECTIONS IN ADHD AND ITS TREATMENT Edited by Jill M. Norvilitis Current Directions in ADHD and Its Treatment Edited by Jill M. Norvilitis Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Igor Babic Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published February, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Current Directions in ADHD and Its Treatment, Edited by Jill M. Norvilitis p. cm. ISBN 978-953-307-868-7 Contents Preface IX Part 1 Treatment Considerations 1 Chapter 1 ADHD in Children and Adolescents: A Good Practice Guidance 3 Somnath Banerjee Chapter 2 ADHD and Comorbid Conditions 25 Nitin Patel, Mita Patel and Harsha Patel Chapter 3 Comorbidity in ADHD: A Neuropsychological Perspective 47 Julio César Flores Lázaro and María Alejandra Salgado Soruco Chapter 4 ADHD and Sleep Problems in Children 61 Elizabeth Hastings and Barbara T. Felt Part 2 Psychopharmacology: Mechanisms and Effects 89 Chapter 5 The Neuropsychopharmacology of Stimulants: Dopamine and ADHD 91 Paul E.A. Glaser and Greg A. Gerhardt Chapter 6 Trends in the Prescribing and Adverse Drug Reactions Patterns of Psychostimulants Among Danish Children and Adolescents 111 Lise Aagaard and Ebba Holme Hansen Chapter 7 Do Stimulant Medications for Attention-Deficit /Hyperactivity Disorder (ADHD) Enhance Cognition? 125 Claire Advokat and Christine Vinci Chapter 8 Motor Skills in Children with ADHD: Comparative Study from the Farmacological Treatment 157 Jose Armando Vidarte Claros and Consuelo Velez Alvarez VI Contents Chapter 9 Methylphenidate and Dyslipidemia 185 Gideon Charach, Nechemia Kaysar, Alexander Rabinovich, Ori Argov and Moshe Weintraub Part 3 Non-Medication Interventions 193 Chapter 10 ADHD and Stress: The Role of Meditation to Reduce Stress, and Improve Brain Function and Behavior Regulation 195 Sarina J. Grosswald and Fred Travis Chapter 11 The Value of Coached Behaviour Modification in the Effective Management of Attention Deficit Hyperactivity Disorder (ADHD) 211 Tilla Olivier and Ana Gomes Chapter 12 Distractor or Noise? The Influence of Different Sounds on Cognitive Performance in Inattentive and Attentive Children 233 Göran Söderlund and Sverker Sikström Part 4 EEG Biofeedback 247 Chapter 13 QEEG Characteristics and Biofeedback Modalities in Children with ADHD 249 Nada Pop-Jordanova Chapter 14 EEG Findings in ADHD and the Application of EEG Biofeedback in Treatment of ADHD 269 Mohammad Ali Nazari Chapter 15 The Effect of Psycho-Educational Therapy on Electroencephalographic Biofeedback Scores in Attention Deficit Hyperactivity Disorder 287 Irene Nikaina, Aspa Paspali, Georgia Kleidaria and Antigone Papavasiliou Preface Attention Deficit Hyperactivity Disorder is one of the most widely diagnosed behavior disorders in childhood, with a worldwide pooled prevalence of 5.29 % (Polanczyk et al., 2007). It is also one of the most controversial diagnoses with concerns raised about whether it is a cultural construct or a neurobehavioral disorder (Barkley et al., 2004, Timimi et al., 2004) and whether it is over diagnosed or under diagnosed. The treatment of ADHD is also a matter of ongoing research and debate, with considerable data supporting both psychopharmacological and behavioral approaches. Researchers continue to search for new interventions to be used in conjunction with or in place of the more traditional approaches. These interventions run the gamut from social skills training, to cognitive behavioral interventions ,to meditation to neuropsychologically- based techniques. This goal of this volume is to explore the state-of-the-art in considerations of the treatment of ADHD around the world. The 16 chapters in this volume represent the work of 27 researchers in countries spanning the globe from Iran to Columbia, Denmark to South Africa , and the United States. Some of the chapters in this book provide a new way of looking at well-established treatments while others examine treatments that are seeking the confirmation of the research community. This broad survey covers issues related to comorbidity that affect the treatment choices that are made, the effects of psychopharmacology, and non-medication treatments, with a special section devoted to the controversial new treatment, neurofeedback. The first section of the book provides an overview of treatment of ADHD and comorbid conditions that may be of concern. Chapter 1, “ADHD in Children and Adolescents: A Good Practice Guidance” provides a summary of the assessment and diagnosis of ADHD. It also concisely describes the management of the disorder, covering such topics as choices and safety in medication, non-medicinal treatments, and a consideration of how comorbid conditions may affect treatment. Chapter 2, “ADHD and Comorbid Conditions,” examines in more depth the identification and treatment of psychological problems that are associated with ADHD, such as depression, anxiety, bipolar disorder, and oppositional defiant disorder. Chapter 3, “Comorbidity in ADHD: A Neuropsychological Perspective,” takes a different approach to the issue from the first two chapters by examining the subtypes of ADHD as related to different neuropsychological profiles. These profiles are in turn related to X Preface different comorbid cognitive and behavioral conditions. The final chapter in the first section, “ADHD and Sleep Problems in Children,” focuses on the need for the consideration of sleep problems in children with ADHD because of the overlap between the two categories and the implications for treatment of ADHD. The second section of the volume examines the psychopharmacological treatment of ADHD. Chapter 5, “The Neuropsychology of Stimulants: Dopamine and ADHD,” examines how dopamine’s role in ADHD is related to the action of psychostimulant medications, as well as the role of other neurotransmitters and other medications. Chapter 6, “Trends in the Prescribing and Adverse Drug Reaction Patterns of Psychostimulants among Danish Children and Adolescents,” takes advantage of the availability of data regarding the individual use of medication in Denmark to explore both changes in prescription rates over a 10 year period and the prevalence of adverse reactions to the various medications. Chapter 7, “Do Stimulant Medications for Attention Deficit Hyperactivity Disorder (ADHD) Enhance Cognition?,” reviews the research on this topic and presents the authors’ own data that indicate that, though stimulants improve attention and concentration, changes in other areas of cognitive and academic functioning are inconsistent such that stimulants do not appear to improve learning. Chapter 8, “Motor Skills in Children with ADHD: Comparative Study from the Pharmacological Treatment,” summarizes the literature indicating that 50 % of children with ADHD have motor skill problems and describes the authors’ own research. Although such problems are common, the effect of medication and exercise on ADHD symptoms and motor disturbance remains unclear. Chapter 9, “Methylphenidate and Dyslipidemia,” examines the relationship between the drug and lipid profiles, concluding that methylphenidate is related to some positive changes in total cholesterol and lipoproteins. The third section of the book moves from psychostimulants to an examination of non- medication treatments. Chapter 10, “Non-Medication Treatments of ADHD,” provides an overview of a variety of interventions, summarizing the techniques and research regarding efficacy. Chapter 11, “ADHD and Stress: The Role of Meditation to Reduce Stress, and Improve Brain Function and Behavior Regulation,” reports the results of two studies examining Transcendental Meditation’s effects on ADHD symptomatology that indicate that children with ADHD are able to learn the technique and that meditation may reduce stress and improve executive functions. Chapter 12, “The Value of Coached Behavior Modification in the Effective Management of Attention Deficit Hyperactivity Disorder (ADHD),” describes research supporting the use of coaches in the treatment of ADHD. Such coaches are not replacements for therapists, but come alongside those with ADHD to help them learn to manage the practical challenges that arise in the pursuit of goals. Chapter 13, “Distractor or Noise? The Influence of Different Sounds on Cognitive Performance in Inattentive and Attentive Children,” reports the results of a study examining the differential response of children with and without inattention symptoms to background auditory noise. The authors report that such noise improves cognitive performance in children with inattentive symptoms and provide a theoretical framework for understanding this phenomenon. [...]... or internet chat lines disrupt the initiation of sleep The bed is not for watching TV, eating, or doing homework No vigorous exercise within two hours of bedtime is recommended Avoid drinks containing caffeine such as chocolate, coffee, tea and cola in the late afternoon and evening and advice a bath before bed to help relax Melatonin is a natural hormone produced by the pineal gland in the brain It... family that makes future visits easier and can aid intervention planning If there are any signs or symptoms of a physical illness that may be a factor in explaining the clinical symptoms, this takes precedence in the evaluation Begin the 16 Current Directions in ADHD and Its Treatment interview by talking about the child’s strengths Ask the child to draw a picture of themselves and then their family on... obtained Eating History should include appetite and eating habits and joining the other members for dinner Physical examination is done to document a baseline growth parameters (height and weight) which should be plotted on a centile chart and at each follow-up visit if the child is prescribed medication, blood pressure and pulse rate are recorded and plotted on the centile chart, cardiac examination including... parents of an ADHD child, the number of possible interventions can be extremely confusing They are likely to hear about a host of treatment options that lack scientific support 20 Current Directions in ADHD and Its Treatment 14 Key points     ADHD is a common behavioural disorder with clear diagnosis criteria ADHD co-exists with other conditions in a high proportion Treatment options for ADHD include... adults Clinical Guideline 72.www.nice.org.uk ADHD in Children and Adolescents: A Good Practice Guidance 23 National Institute for Health and Clinical Excellence (2009) Medicines adherence: Involving patients in decisions about prescribed medicines and supporting adherence Clinical guideline 76, 2009 www.nice.org.uk/CG76 (accessed on 18 April 2010) Orford E (1998) Commentary: Diagnosis needs tightening... understanding of the side effects and lack of liaison between the clinician and parents The common side-effects reported with MPH are insomnia, decreased appetite, pain in abdomen and headache They are often mild and transient, and may be alleviated by reducing or adjusting the dosage Many parents complain that their children are 'picky eaters' In addition, both stimulant and non-stimulant ADHD medication... should include information gathering Apart from obtaining the completed rating scales, information should be obtained from the school about peer relationship and the child’s academic progress Information is gathered about child’s current difficulties; family and social history; child’s developmental and medical history and the educational progress While interviewing parents, one needs to obtain a comprehensive... trials involving over 4000 children and adolescents with ADHD Peak efficacy occurs between 2 and 6 weeks after initiation, in contrast to the stimulants, which provide a response within hours It is safe, well tolerated, and effective in 6 published trials in children and adolescents (Corman et al., 2004) Labelling for ATX includes "Black Box" warning for severe liver injury since February 2005, and for... combination of treatments accelerated the improvement in brain activity Overall, the chapters presented here tap intomuch of the breadth of this field I believe that there is something in this volume for everyone interested in the treatment of ADHD, from students examining the topic for the first time to researchers and practitioners looking for inspiration for new research questions or potential interventions... family to find out more about ADHD through reputable websites and recommended reading They need to be informed of the symptoms that indicate a diagnosis and the aims and rationale for treatment (with an understanding that no medication eliminates all the symptoms of ADHD and that other strategies are also indicated as part of management) There needs to be a discussion of the risks and benefits of the . CURRENT DIRECTIONS IN ADHD AND ITS TREATMENT Edited by Jill M. Norvilitis Current Directions in ADHD and Its Treatment Edited by Jill M obtained. Eating History should include appetite and eating habits and joining the other members for dinner. Physical examination is done to document a baseline growth parameters (height and. ADHD. Chapter 15, “EEG Findings in ADHD and the Application of EEG Biofeedback in Treatment of ADHD, ” provides a more extensive description of EEG biofeedback, including summaries of the treatment