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RE: severity of abuse & ADHD
Interesting question about the comorbidity of SA with ADHD. The American
Academy of Pediatrics just published their evaluation and diagnosis practice
guidelines on May 1, which are "evidence based" guidelines (read -- review
of scientific literature and evaluation of the quality of the science --
they used AHCPR process for developing guidelines). In addition, the
American Academy of Child and Adolescent Psychiatry have guidelines for
assessing, diagnosing and treating ADHD. The major messages for diagnosis
include the following:
* diagnosis is based on the presence and severity of behavioral sympotoms
described in the DSM-IV and impairment in functioning
* symptoms need to be present for 6 months, in multiple settings, and
present in some form before the age of 7 years.
* evaluation process includes interviewing multiple informants including
parent(s),teacher, and youth. While the phyisical exam is necessary to rule
out conditions and address neurological issues (impaired fine motor
coordination is often co-morbid with ADHD)there is no physical sign/test for
confirming the diagnosis of ADHD.
* co-morbidity with various conditions is the rule with ADHD, which must be
addressed by the evaluation
The bottom line is there is no diagnostic test that confirms the
presence/absence of ADHD -- the diagnosis is based on behaviors and none of
the behaviors are only seen with ADHD. On going research is looking at
organic "causes" for ADHD but I think there is a lot of work to be done in
the field.
Here are some websites you might find helpful-
http://www.aap.org/policy/paramtoc.html -- AAP ADHD guidelines
http://www.nimh.nih.gov/events/mtaqa.cfm
http://odp.od.nih.gov/consensus/cons/110/110_intro.htm
Hope this helps. I don't know if anyone is doing a study to address your
question but one of the largest studies involving ADHD, Multimodal Treatment
Study, was sponsored by NIMH -- see the above web pages. They may have some
data that could help.
Julie Rosof-Williams, RN, MSN
Graduate Student
Vanderbilt University
-----Original Message-----
From: owner-CHILD-MALTREATMENT-RESEARCH-L@cornell.edu
[mailto:owner-CHILD-MALTREATMENT-RESEARCH-L@cornell.edu]On Behalf Of
Lisa Amaya-Jackson
Sent: Tuesday, May 23, 2000 10:42 AM
To: Child Maltreatment Researchers
Subject: severity of abuse & ADHD
-----Original Message-----
From: Jschiff139@aol.com [SMTP:Jschiff139@aol.com]
Sent: Monday, May 22, 2000 6:03 PM
To: Child Maltreatment Researchers
Subject: Re: severity of abuse
What is the basis of the assumption that the rate of ADD or ADHD diagnosis
is
necessarily related to the incidence of abuse or neglect? Is this because
it
is assumed that the diagnosis is simply given as a label affixed to out of
control children? Is there some hypothesis that ADD/ADHD is caused by
abuse? Or is it an assumption that there is no such animal and it's a
method
to excuse behavior and/or drug children?
Jonathan E. Schiff
Jonathan-
Many children with child abuse and neglect (and other traumas) are diagnosed
with ADHD and the issue of why and what the appropriate treatment is
not-too-often addressed in the literature. In a recent paper we wrote about
this and so it was easy for me to cut and paste:
(citation Donnelly, Amaya-Jackson, March, 1999, article on child PTSD)
"The same brain areas that are involved in the stress response also mediate
motor behavior, affect regulation, arousal, sleep, startle response,
attention, and cardiovascular responsivity. Hence, it is not unusual for
traumatized children, particularly those exposed to chronic trauma like
maltreatment, to exhibit what appears to be a constellation of anxiety plus
ADHD and other disruptive behavior symptoms. Whether this is true
comorbidity or an overlap in diagnostic criteria shared by the disorders has
been an area of some controversy (Cuffe et al., 1994). It is worth noting
that many children are treated for ADHD with psychostimulants by family
physicians, pediatricians and psychiatrists without recognition that there
is underlying trauma. While some clinicians who recognize trauma along with
externalizing behavior symptoms will consider the use of alpha-agonists,
hoping to avoid stimulant induced exacerbation of anxiety and PTSD, many
children in fact have favorable responses in reduction of hyperactivity,
impulse dyscontrol and attention impairment, with the psychostimulants such
as Methylphenidate or Dextroamphetamine. Similarly, Buproprion is often
considered a second line agent for ADHD symptoms and may be a useful agent
when affect dysregulation or depressed mood occurs with ADHD symptoms. There
have been no research studies in children or adolescents looking at the use
of stimulants or Buproprion in Pediatric PTSD. However, taking into
consideration the dysregulated, allostatic neurophysiological state of
catecholamine responsivity that traumatized children may exhibit (Perry,
1995) it would seem that such studies are clearly indicated. "
Lisa a-j
Lisa Amaya-Jackson, MD, MPH
Asst. Professor in Psychiatry & Behavioral Sciences, Duke Univ. Medical
Center
Director, Trauma Evaluation, Research, & Treatment Program
Center for Child & Family Health, NC
(Collaboration of University of N.C., Duke University, & N.C. Central
University)
3518 Westgate Dr., Suite 100, Durham, NC 27707
919-419-3474x405 FAX: 919-419-9353 Email: LAJ@DUKE.EDU