Tag Archives: Contrasting parents’ and pediatricians’ perspectives on shared decision-making in ADHD.

An ADHD related disorder: ‘Sluggish Cognitive Tempo’

12 Apr

Tania Tirraoro posted the article, It’s not ADHD, it’s Sluggish Cognitive Tempo at Special Needs jungle:

Have you heard of “Sluggish Cognitive Tempo” (SCT)? It’s apparently regarded by psychiatric professionals as a subtype of attention-deficit/hyperactivity disorder (ADHD). Until now, that is.
Medscape has reported some research that concludes it is most likely to be a distinct attention disorder, although there is notable overlap with ADHD.
The researchers, Dr Catherine Saxbe and Dr Russell A. Barkley from the Medical University of South Carolina in the US, have based their findings on reviewing nearly three decades’ worth of research on SCT and their own clinical experience. They’re predicting that, given the evidence, SCT may “eventually be accepted as an identifiable attention disorder with its own diagnostic criteria that distinguish it from ADHD.”. Writing in the Journal of Psychiatric Practice they claim that SCT may represent an exciting new frontier in psychiatry.
Characteristics of Sluggish Cognitive Tempo
• Like ADHD, SCT typically presents in childhood.
• Being daydreamy, mentally foggy, and easily confused.
• Staring frequently.
• May have symptoms of hypoactivity, lethargy, slow movement, possibly sleepiness.
• Children with SCT also appear to have slow processing speed and reaction times.
There are no officially endorsed criteria for SCT but the researchers believe that may change in the “foreseeable future,” and that most doctors who see children with ADHD have probably come across someone who falls within the parameters of SCT.
First, there needs to be more research on the cognitive deficits, such as which areas of the brain are most active when the patient appears the most distracted ― in other words the researchers say, “where does the mind go?” http://www.specialneedsjungle.com/adhd-sluggish-cognitive-tempo/

See, Slow Cognitive Tempo (SCT): The Second Attention Disorder http://www.youtube.com/watch?v=1t7X6uhgB4E

Alan Schwartz reported in the New York Times article, Idea of New Attention Disorder Spurs Research, and Debate:

With more than six million American children having received a diagnosis of attention deficit hyperactivity disorder, concern has been rising that the condition is being significantly misdiagnosed and overtreated with prescription medications.
Yet now some powerful figures in mental health are claiming to have identified a new disorder that could vastly expand the ranks of young people treated for attention problems. Called sluggish cognitive tempo, the condition is said to be characterized by lethargy, daydreaming and slow mental processing. By some researchers’ estimates, it is present in perhaps two million children.
Experts pushing for more research into sluggish cognitive tempo say it is gaining momentum toward recognition as a legitimate disorder — and, as such, a candidate for pharmacological treatment. Some of the condition’s researchers have helped Eli Lilly investigate how its flagship A.D.H.D. drug might treat it.
The Journal of Abnormal Child Psychology devoted 136 pages of its January issue to papers describing the illness, with the lead paper claiming that the question of its existence “seems to be laid to rest as of this issue.” The psychologist Russell Barkley of the Medical University of South Carolina, for 30 years one of A.D.H.D.’s most influential and visible proponents, has claimed in research papers and lectures that sluggish cognitive tempo “has become the new attention disorder.”
In an interview, Keith McBurnett, a professor of psychiatry at the University of California, San Francisco, and co-author of several papers on sluggish cognitive tempo, said: “When you start talking about things like daydreaming, mind-wandering, those types of behaviors, someone who has a son or daughter who does this excessively says, ‘I know about this from my own experience.’ They know what you’re talking about.”
Yet some experts, including Dr. McBurnett and some members of the journal’s editorial board, say that there is no consensus on the new disorder’s specific symptoms, let alone scientific validity. They warn that the concept’s promotion without vastly more scientific rigor could expose children to unwarranted diagnoses and prescription medications — problems that A.D.H.D. already faces.
“We’re seeing a fad in evolution: Just as A.D.H.D. has been the diagnosis du jour for 15 years or so, this is the beginning of another,” said Dr. Allen Frances, an emeritus professor of psychiatry at Duke University. “This is a public health experiment on millions of kids.”
Though the concept of sluggish cognitive tempo, or S.C.T., has been researched sporadically since the 1980s, it has never been recognized in the Diagnostic and Statistical Manual of Mental Disorders, which codifies conditions recognized by the American Psychiatric Association. The editor in chief of The Journal of Abnormal Child Psychology, Charlotte Johnston, said in an email that recent renewed interest in the condition is what led the journal to devote most of one issue to “highlight areas in which further study is needed…” http://www.nytimes.com/2014/04/12/health/idea-of-new-attention-disorder-spurs-research-and-debate.html?ref=education&_r=0

Citation:

Journal of Abnormal Child Psychology
January 2014, Volume 42, Issue 1, pp 1-6
Sluggish Cognitive Tempo in Abnormal Child Psychology: An Historical Overview and Introduction to the Special Section
• Stephen P. Becker,
• Stephen A. Marshall,
• Keith McBurnett
• …show all 3hide
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Abstract
There has recently been a resurgence of interest in Sluggish Cognitive Tempo (SCT) as an important construct in the field of abnormal child psychology. Characterized by drowsiness, daydreaming, lethargy, mental confusion, and slowed thinking/behavior, SCT has primarily been studied as a feature of Attention-Deficit/Hyperactivity Disorder (ADHD), and namely the predominately inattentive subtype/presentation. Although SCT is strongly associated with ADHD inattention, research increasingly supports the possibility that SCT is distinct from ADHD or perhaps a different mental health condition altogether, with unique relations to child and adolescent psychosocial adjustment. This introductory article to the Special Section on SCT provides an historical overview of the SCT construct and briefly describes the contributions of the eight empirical papers included in the Special Section. Given the emerging importance of SCT for abnormal psychology and clinical science, there is a clear need for additional studies that examine (1) the measurement, structure, and multidimensional nature of SCT, (2) SCT as statistically distinct from not only ADHD-inattention but also other psychopathologies (particularly depression and anxiety), (3) genetic and environmental contributions to the development of SCT symptoms, and (4) functional impairments associated with SCT. This Special Section brings together papers to advance the current knowledge related to these issues as well as to spur research in this exciting and expanding area of abnormal psychology.
Look
Inside
Citations
Within this Article
1. An Historical Overview of SCT
2. Special Section Studies
3. Conclusion
4. References
5. References
References (46)
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About this Article
Title
Sluggish Cognitive Tempo in Abnormal Child Psychology: An Historical Overview and Introduction to the Special Section
Journal
Journal of Abnormal Child Psychology
Volume 42, Issue 1 , pp 1-6
Cover Date
2014-01-01
DOI
10.1007/s10802-013-9825-x
Print ISSN
0091-0627
Online ISSN
1573-2835
Publisher
Springer US

Reference Links:

Edge Foundation ADHD Coaching Study Executive Summary http://edgefoundation.org/wp-content/uploads/2011/01/Edge-Foundation-ADHD-Coaching-Research-Report.pdf

Edge Foundation ADHD Coaching Study Full Report http://edgefoundation.org/wp-content/uploads/2011/01/Edge-Foundation-ADHD-Coaching-Research-Report.pdf

ADHD and College Success: A free guide http://www.edgefoundation.org/howedgehelps/add-2.html

ADHD and ExecutiveFunctioning http://edgefoundation.org/blog/2010/10/08/the-role-of-adhd-and-your-brains-executive-functions/

Executive Function, ADHD and Academic Outcomes http://www.helpforld.com/efacoutcomes.pdf

If you suspect that your child might have ADHD, you should seek an evaluation from a competent professional who has knowledge of this specialized area of medical practice.

Related:

Studies: ADHD drugs don’t necessarily improve academic performance https://drwilda.com/2013/07/14/studies-adhd-drugs-dont-necessarily-improve-academic-performance/

ADHD coaching to improve a child’s education outcome https://drwilda.com/2012/03/31/adhd-coaching-to-improve-a-childs-education-outcome/

Where information leads to Hope. © Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:
COMMENTS FROM AN OLD FART© http://drwildaoldfart.wordpress.com

Dr. Wilda Reviews © http://drwildareviews.wordpress.com/

Dr. Wilda © https://drwilda.com/

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Children’s Hospital of Philadelphia study: Parent’s attitudes determine ADHD treatment

6 Sep

Many parents will be presented with a diagnosis of ADHD regarding their child. Yahoo medical reported in the article, Top 10 Myths About ADHD:

Myth #1: Only kids have ADHD.
Although about 10% of kids 5 to 17 years old have been diagnosed with ADHD, at least 4% of adults have it, too — and probably many more, since adult ADHD is often undiagnosed or misdiagnosed. That’s partly because people think only kids get it.

Myth #2: All kids “outgrow” ADHD.
Not nearly always. Up to 70% of children with ADHD continue to have trouble with it in adulthood, which can create relationship problems, money troubles, work strife, and a rocky family life.

Myth #3: Medication is the only treatment for ADHD.
Medication can be useful in managing ADHD symptoms, but it’s not a cure. And it’s not the only treatment. Lifestyle changes, counseling, and behavior modification can significantly improve symptoms as well. Several studies suggest that a combination of ADHD treatments works best.

Myth #4: People who have ADHD are lazy and lack intelligence and willpower.
This is totally not true. In fact, ADHD has nothing to do with intelligence or determination. It’s a neurobehavioral disorder caused by changes in brain chemicals and the way the brain works. It presents unique challenges, but they can be overcome — which many successful people have done. Even Albert Einstein is said to have had symptoms of ADHD.

Myth #5: ADHD isn’t a real disorder.
Not so. Doctors and mental-health professionals agree that ADHD is a biological disorder that can significantly impair functioning. An imbalance in brain chemicals affects brain areas that regulate behavior and emotion. This is what produces ADHD symptoms.

Myth #6: Bad parenting causes ADHD.
Absolutely not! ADHD symptoms are caused by brain-chemical imbalances (see #4 and #5) that make it hard to pay attention and control impulses. Good parenting skills help children deal with their symptoms.

Myth #7: Kids with ADHD are always hyper.
Not always. ADHD comes in three “flavors”: predominantly inattentive; predominantly hyperactive-impulsive; and combined, which is a mix of inattentive and hyperactive-impulsive symptoms. Although kids with hyperactive-impulsive or combined ADHD may be fidgety and restless, kids with inattentive ADHD are not hyper.

Myth #8: Too much TV time causes ADHD.
Not really. But spending excessive amounts of time watching TV or playing video games could trigger the condition in susceptible individuals. And in kids and teens who already have ADHD, spending hours staring at electronic screens may make symptoms worse.

Myth #9: If you can focus on certain things, you don’t have ADHD.
It’s not that simple. Although it’s true that people with ADHD have trouble focusing on things that don’t interest them, there’s a flip side to the disorder. Some people with ADHD get overly absorbed in activities they enjoy. This symptom is called hyperfocus. It can help you be more productive in activities that you like, but you can become so focused that you ignore responsibilities you don’t like.

Myth #10: ADHD is overdiagnosed.
Nope. If anything, ADHD is underdiagnosed and undertreated. Many children with ADHD grow up to be adults with ADHD. The pressures and responsibilities of adulthood often exacerbate ADHD symptoms, leading adults to seek evaluation and help for the first time. Also, parents who have children with ADHD may seek treatment only after recognizing similar symptoms in themselves.
http://shine.yahoo.com/parenting/top-10-myths-about-adhd-2528710.html

Whether drug or behavior therapy is chosen to treat ADHD depends upon the goals of the parents.

Genevra Pittman reported in the article, ADHD Treatment: Parents’ Goals Tied To Choice Of Behavior Therapy Or Medication (STUDY):

(Reuters Health) – Parents’ goals and concerns for their children with attention-deficit/hyperactivity disorder may influence their decision to start behavior therapy or medication, according to a new study that researchers say supports a shared decision-making approach to ADHD treatment.
Researchers found parents who were focused on their child’s academic achievement were twice as likely to have the child started on medications, which include Adderall and Ritalin, as other parents.
Parents who expressed goals of improved behavior and interpersonal relationships were 60 percent more likely to start behavior therapy – which involves parents meeting with a counselor to learn how to manage a child’s behavior.
“Studies like this really suggest that taking a shared decision-making approach may be one way to match the kids for whom (treatment) is warranted to the best treatment,” Dr. Alexander Fiks, from The Children’s Hospital of Pennsylvania in Philadelphia, said.
“For parents, the real thing is to ask pediatricians to really explain the pluses and minuses of all of the different options, and to make sure they can articulate what they’re really most hoping to achieve,” Fiks, the study’s lead author, told Reuters Health.
http://www.huffingtonpost.com/2013/09/02/adhd-treatment-parents-goals_n_3857116.html?utm_hp_ref=email_share

The medical Xpress article, Engaging parents leads to better treatments for children with adhd reported about the ADHD study:

Pediatricians and researchers at The Children’s Hospital of Philadelphia’s(CHOP) have developed a first-of-its kind tool to help parents and health care providers better treat ADHD (attention deficit-hyperactivity disorder). The new, three-part survey helps steer families and doctors toward “shared decision-making”, an approach proven to improve healthcare results in adults, but not widely used in pediatric settings. The results of the CHOP study are published in the journal Academic Pediatrics.
“Shared decision-making in health care means that doctors and families make decisions together. Doctors contribute their professional knowledge, and families weigh their values and personal experience,” explained lead author Alexander Fiks, M.D., M.S.C.E, an urban primary care pediatrician at CHOP and a faculty member at CHOP’s PolicyLab. “We chose to focus on ADHD for this study, because it is a relatively common diagnosis with two recommended treatment options – prescription medication and behavioral therapy – that require the family to make decisions about what will work best for them. Choosing a treatment that doesn’t ‘fit’ can lead to unsuccessful results. We wanted to see if we could create a tool to help guide families and physicians through this process.”
According to a study published earlier this year, the number of physician outpatient visits in which ADHD was diagnosed in children under age 18 was 10.4 million. Psychostimulants were used in 87 percent of treatments prescribed during those visits.
The CHOP study involved 237 parents of children aged 6-12 who were diagnosed with ADHD within the past 18 months. Using a combination of parent interviews, current research, and input from parent advocates and professional experts, researchers developed a standardized three-part questionnaire to help parents define and prioritize their goals for treatment; attitudes toward medication; and comfort with behavioral therapies. The completed survey serves as a guide to support families and health care providers to reach the most effective and workable treatment for a child’s ADHD.
“It’s important to know whether a parent’s primary goal is to keep a child from getting in trouble at school, improve academic performance, or maintain more peace with family members or peers,” said Fiks. “We also need to learn about the family’s lifestyle and attitudes toward behavioral therapy and medication. All of these factor into making the best treatment decision for each individual child and family.” http://medicalxpress.com/news/2012-10-engaging-parents-treatments-children-adhd.html

Citation:

Contrasting parents’ and pediatricians’ perspectives on shared decision-making in ADHD.
Fiks AG, Hughes CC, Gafen A, Guevara JP, Barg FK.
Source
Pediatric Research Consortium, Children’s Hospital of Philadelphia, 3535 Market St, Room 1546, Philadelphia, PA 19104, USA. fiks@email.chop.edu
Abstract
OBJECTIVE:
The goal was to compare how parents and clinicians understand shared decision-making (SDM) in attention-deficit/hyperactivity disorder (ADHD), a prototype for SDM in pediatrics.
METHODS:
We conducted semi-structured interviews with 60 parents of children 6 to 12 years of age with ADHD (50% black and 43% college educated) and 30 primary care clinicians with varying experience. Open-ended interviews explored how pediatric clinicians and parents understood SDM in ADHD. Interviews were taped, transcribed, and then coded. Data were analyzed by using a modified grounded theory approach.
RESULTS:
Parents and clinicians both viewed SDM favorably. However, parents described SDM as a partnership between equals, with physicians providing medical expertise and the family contributing in-depth knowledge of the child. In contrast, clinicians understood SDM as a means to encourage families to accept clinicians’ preferred treatment. These findings affected care because parents mistrusted clinicians whose presentation they perceived as biased. Both groups discussed how real-world barriers limit the consideration of evidence-based options, and they emphasized the importance of engaging professionals, family members, and/or friends in SDM. Although primary themes did not differ according to race, white parents more commonly received support from medical professionals in their social networks.
CONCLUSIONS:
Despite national guidelines prioritizing SDM in ADHD, challenges to implementing the process persist. Results suggest that, to support SDM in ADHD, modifications are needed at the practice and policy levels, including clinician training, incorporation of decision aids and improved strategies to facilitate communication, and efforts to ensure that evidence-based treatment is accessible.
PMID:
21172996
[PubMed – indexed for MEDLINE]
PMCID:
PMC3010085
Free PMC Article
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3010085/

The Centers for Disease Control provides great information in the article, Attention-Deficit / Hyperactivity Disorder (ADHD):
Treatment

On This Page
• Medications
• Behavioral intervention strategies
• Parent Education and Support
• Behavior Treatment for Preschoolers
• ADHD and School
• Related Pages
My Child Has Been Diagnosed with ADHD – Now What?
It is understandable for parents to have concerns when their child is diagnosed with ADHD, especially about treatments. It is important for parents to remember that while ADHD can’t be cured, it can be successfully managed. There are many treatment options, so parents and doctors should work closely with everyone involved in the child’s treatment — teachers, coaches, therapists, and other family members. Taking advantage of all the resources available will help you guide your child towards success. Remember, you are your child’s strongest advocate!
In most cases, ADHD is best treated with a combination of medication and behavior therapy. Good treatment plans will include close monitoring, follow-ups and any changes needed along the way.
Following are treatment options for ADHD:
Behavior Treatment for Preschoolers
Click here to learn more »
• Medications
• Behavioral intervention strategies
• Parent training
• ADHD and school

To go to the American Academy of Pediatrics (AAP) policy statement on the treatment of school-aged children with ADHD, visit the Recommendations page.
Medications
Medication can help a child with ADHD in their everyday life and may be a valuable part of a child’s treatment. Medication is one option that may help better control some of the behavior problems that have led to trouble in the past with family, friends and at school.
Several different types of medications may be used to treat ADHD:
• Stimulants are the best-known and most widely used treatments. Between 70-80 percent of children with ADHD respond positively to these medications.
• Nonstimulants were approved for treating ADHD in 2003. This medication seems to have fewer side effects than stimulants and can last up to 24 hours.
Medications can affect children differently, where one child may respond well to one medication, but not another. When determining the best treatment, the doctor might try different medications and doses, so it is important to work with your child’s doctor to find the medication that works best for your child.
For more information on treatments, please click one of the following links:
National Resource Center on ADHD
National Institute of Mental Health
Behavioral Therapy
Research shows that behavioral therapy is an important part of treatment for children with ADHD. ADHD affects not only a child’s ability to pay attention or sit still at school, it also affects relationships with family and how well they do in their classes. Behavioral therapy is another treatment option that can help reduce these problems for children and should be started as soon as a diagnosis is made.
Following are examples that might help with your child’s behavioral therapy:
• Create a routine. Try to follow the same schedule every day, from wake-up time to bedtime.
• Get organized . Put schoolbags, clothing, and toys in the same place every day so your child will be less likely to lose them.
• Avoid distractions. Turn off the TV, radio, and computer, especially when your child is doing homework.
• Limit choices. Offer a choice between two things (this outfit, meal, toy, etc., or that one) so that your child isn’t overwhelmed and overstimulated.
• Change your interactions with your child. Instead of long-winded explanations and cajoling, use clear, brief directions to remind your child of responsibilities.
• Use goals and rewards. Use a chart to list goals and track positive behaviors, then reward your child’s efforts. Be sure the goals are realistic—baby steps are important!
• Discipline effectively. Instead of yelling or spanking, use timeouts or removal of privileges as consequences for inappropriate behavior.
• Help your child discover a talent. All kids need to experience success to feel good about themselves. Finding out what your child does well — whether it’s sports, art, or music — can boost social skills and self-esteem.
Parent Education and Support
Parent education and support are other important parts of treatment for a child with ADHD. Children with ADHD might not respond as well as other children to the usual parenting practices, so experts recommend additional parent education. This approach has been successful in teaching parents how to help their children become better organized, develop problem-solving skills, and cope with their ADHD symptoms.
Parent education can be conducted in groups or with individual families and is offered by therapists or in special classes. Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD) offers a unique educational program to help parents and individuals with ADHD navigate the challenges of ADHD across the lifespan. Find more information about CHADD’s “Parent to Parent” program by visiting CHADD’s website .
Behavior Treatment for Preschoolers
The 2011 clinical practice guidelines from the American Academy of Pediatrics recommend that doctors prescribe behavior interventions that are evidence based as the first line of treatment for preschool-aged children (4–5 years of age) with ADHD. Parents or teachers can provide this treatment.
The Agency for Health Care Research and Quality (AHRQ) conducted a review in 2010 of all existing studies on treatment options for preschoolers. The review found enough evidence to recommend parent behavioral interventions as a good treatment option for preschoolers with disruptive behavior in general and as helpful for those with ADHD symptoms.
The AHRQ review found that effective parenting programs help parents develop a positive relationship with their child, teach them about how children develop, and help them manage negative behavior with positive discipline. The review also found four programs for parents of preschoolers that include these key components:
• Triple P (Positive Parenting of Preschoolers program),
• Incredible Years Parenting Program
• Parent-Child Interaction Therapy
• New Forest Parenting Program—Developed specifically for parents of children with ADHD [Abstract ] [Authors ]
Read the full AHRQ report here .
ADHD and the Classroom
Just like with parent training, it is important for teachers to have the needed skills to help children manage their ADHD. However, since the majority of children with ADHD are not enrolled in special education classes, their teachers will most likely be regular education teachers who might know very little about ADHD and could benefit from assistance and guidance.
Here are some tips to share with teachers for classroom success:
• Use a homework folder for parent-teacher communications
• Make assignments clear
• Give positive reinforcement
• Be sensitive to self-esteem issues
• Involve the school counselor or psychologist
What Every Parent Should Know…
As your child’s most important advocate, you should become familiar with your child’s medical, legal, and educational rights. Kids with ADHD might be eligible for special services or accommodations at school under the Individuals with Disabilities in Education Act (IDEA) and an anti-discrimination law known as Section 504. To learn more about Section 504, click here .
Related Pages
• Child Development
• Positive Parenting Tips
• Injury, Violence, and Safety
• Safe and Healthy Kids and Teens
• CDC’s National Center on Birth Defects and Developmental Disabilities
http://www.cdc.gov/ncbddd/adhd/treatment.html

A Healthy Child In A Healthy Family Who Attends A Healthy School In A Healthy Neighborhood. ©

If you suspect that your child might have ADHD, you should seek an evaluation from a competent professional who has knowledge of this specialized area of medical practice.

Related:
Studies: ADHD drugs don’t necessarily improve academic performance

Studies: ADHD drugs don’t necessarily improve academic performance

ADHD coaching to improve a child’s education outcome

ADHD coaching to improve a child’s education outcome

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