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 Clinical Psychology Associates of North Central Florida    CPANCF.COM    352 336-2888

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Ernest J. Bordini, Ph.D., Licensed Psychologist
Presented to Chadd of Alachua County 3/21/02                                                      

Attention-deficit Hyperactivity Disorder (ADHD) is the single most prevalent psychiatric disorder among elementary school children. ADHD is a childhood disorder previously labeled hyperactivity, hyperkinesis, minimal brain dysfunction, minimal brain damage, minimal or minor cerebral dysfunction.

Prevalence rates from 3% to 5% of school age children.  Males are over representing from 5 to 10 : 1. Depending on criteria uses some researchers estimate as many as 10-20% prevalence rates. Longitudinal studies of children with ADHD into adolescence found continued symptoms in 20% to 80% of probands studied.


About half of ADHD children have a coexisting oppositional or conduct disorder. These children show temper outbursts, argumentativeness, defiance, and aggressiveness.  A study by Taylor et al suggested the presence of oppositional (ODD) or conduct (CD) problems does not affect the probability of a positive response to stimulants. Children with ADD and CD respond to stimulant therapy just as well as those without a conduct disorder. The same study also showed that measures of family function had no relationship to stimulant response.

A study of 1300 children by Davidson et al., 1992, found no relationship between symptoms of hyperactivity and injury. But the coexistence of conduct disorder seemed to be a major risk factor in ADHD children. However, 16- to 22-year-old ADHD individuals when matched with controls had almost four times the number of motor vehicle accidents and four times the rate of traffic citations (1993).  Thus, monitoring teen ADHD driving and modeling safe driving practices are even more important in families who have ADHD children.

Nine to 10% (or more) of ADD children have learning disabilities (Halperin 1984). Up to 30 to 40 % of learning disabled children may also have ADHD (Levine, 1982, Hobrow, 1986). ADHD children in general tend to be behind in reading and arithmetic (Holborow and Berfrry 1986). The frequent co-existence of these disorders suggests that a thorough pediatric neuropsychological assessment be completed for these children.

The frequency of speech and language problems is inconsistent across studies but are more likely to involve expressive rather than receptive language. This might involve dysfluent speech and problems of articulation. This more likely in those children with ADD and LD. A finding of reduced verbal fluency in ADHD children, was reported by Kozill, et. al., 1992.

Steven Henshaw, in a 1992 article in the JCCP, Number 60, 890 - 903 found treatment of behavior problems in ADHD children with learning problems is often not adequate if assistance for academic deficiencies is not provided.

Social skill problems are not uncommon in ADHD children. Poor social skills often lead to being teased or rejected by peers and contributes to low self-esteem.  Social skill problems can also be seen in children with nonverbal learning disabilities or Autism Spectrum Disorder, but it is important not to mistake the common social skill problems of ADHD children with the more severe disturbance in social awareness and reciprocity seen in Autism Spectrum Disorder.

Encopresis and Enuresis are not unusual in children with ADHD.  ADHD children had rates of enuresis of 43% vs 38% of matched normal children. 56% may have sleep difficulties.

ADHD children may display nonlocalized "soft" pediatric neurological signs, poor eye hand coordination, and perceptual motor dysfunction. Slightly more than 50% ADD children have motor problems relative to a 35% base rate in normals. They may show motor overflow, motor impersistence, and poor handwriting. Many perform poorly on Pegboard tasks.

Up to 25% of ADHD meet the criteria for anxiety or phobic disorder and 1/3 preadolescent children with anxiety showed 1/3 had ADHD. Higher levels of anxiety and depressive symptoms in children with attention-deficit hyperactivity disorder may predict a nonresponse to stimulant medication. However mild anxiety is not a contraindication to stimulant treatment.

A study published in the Journal of Abnormal Child Psychology, in 1993, followed over a thousand children for fifteen years and found there is no greater than expected association between allergic disorders and ADHD.

The presence and severity of ADHD was evaluated in eighteen families with history of "generalized resistance to thyroid hormone". About 50% of the adults and 70% of the children met the criteria for ADHD. However, few people with ADHD have thyroid disorders. It is suggested if ADHD difficulties are present and there is a family history of thyroid difficulties, further evaluation may be indicated.

Over 50% of Tourette's syndrome individuals have attention deficit disorder but only 5% of ADHD children have Tourette's syndrome. Tourette's children with ADD exhibited significant differences from non-ADHD children on SSPT, TMT, and DS (Yates, 1994).  Some Tourette's children show patterns of deteriorating neuropsychological test performance with time.

ADHD has been associated with increased risk for bipolar disorder, which involves periods of depression and cyclic mood changes of briefer and less intense hypomanic episodes or longer and more severe manic episodes. Most of the medications used to treat bipolar disorder have more severe side effects and risks than the stimulants and SSRI medications usually used to treat ADHD, warranting careful diagnostic assessment. Diagnostic errors are easy to make since there is a 70% overlap of symptoms, but the key difference is that the impulsive and restless behaviors of ADHD individuals tend to be rather constant and that in bipolar conditions tends to occur episodically often with no clear precipitant. For more on the diagnostic differential of ADHD and Bipolar Disorder, see Issues in Diagnosis of Pediatric Bipolar Disorder versus ADHD.

Careful and thorough pediatric neuropsychological assessment of possible co-existing conditions is often relevant for treatment planning, accommodations and medication approaches.


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