1. No category

Attention Deficit/Hyperactivity Disorder (ADHD) Clinical Guidelines
Developed in collaboration with the mental health centers associated with NBHP and FBHP
DSM-IV-TR Diagnostic Code: 314.01; 314.00; 314.9
Unless otherwise noted, guidelines apply to both adults and children with ADHD
Diagnostic Considerations:
1. Review diagnostic criteria in DSM. Core symptoms of ADHD include: inattention,
impulsivity, and/or hyperactivity. The DSM defines 3 subtypes: predominantly inattentive type,
predominantly hyperactive or combined type. Females with ADHD more often present as
inattentive, whereas males tend to exhibit more symptoms of hyperactivity.
2. Assessment and diagnosis should come from a synthesis of information gathered from a
variety of sources. Reports from parents and/or significant others are important for accurate
diagnosis. ADHD is highly heritable, and family history of ADHD should be assessed, along
with family history of other mental health disorders.
For children: be aware that when interviewed alone, children with ADHD often benefit
from the individual adult attention and structure and may not display as many ADHD
symptoms as in other situations. In assessing symptoms at school, ask the parent about
the teacher’s style. Teachers who provide more structure will pick up on symptoms more
quickly than those who are more lax. Similarly, parenting styles will affect how easily
parents notice the symptoms.
For adults: symptoms should be diagnosable in childhood, as adult-onset ADHD is
contrary to the natural history of this disorder. School, work, and social development
should be considered.
3. Commonly used rating scales for ADHD
For children: use reports from parents/primary caretakers, school, and an interview of
the child. Standardized rating scales, such as Conners Behavior Rating Scale (CBRS)
from multiple informants is highly desirable. Additional behavior scales, such as Child
Behavioral Checklist (CBCL) or Behavior Assessment System for Children (BASC) can
be helpful for differential diagnosis or diagnosis of co-occurring conditions.
For adults: Brown ADD Scale for Adults, Conners Adult ADHD Rating Scales, and
Adult ADHD Self-Report Scale by WHO.
4. Assess for strengths, resources, and environmental stressors of the client and their support
systems. Consistency of support by family and school caregivers can facilitate positive change.
Focus on the client’s current coping strategies and areas of effectiveness can foster hope and
motivation in the client and family.
5. Co-occurring disorders are common with ADHD.
For children: research indicates that as many as one third of children with ADHD have a
co-occurring condition, in particular oppositional defiant disorder, conduct disorder,
anxiety and mood disorders. Learning, speech and language disorders, as well as
developmental disorders, should be considered.
For adolescents and adults: if untreated for ADHD, there is a higher incidence of
substance abuse than the general population. Secondary disorders should be assessed as
they can complicate treatment.
Revised 6/1/2012
6. Differential diagnosis should include mania or a bipolar mixed state, which may be difficult
to distinguish from ADHD. ADHD is likely to have an earlier onset, sustained clinical course,
and a family history of attention disorders.
For children: chronic family discord, academic placement and other environmental
factors can cause symptoms that appear similar to ADHD. Additional factors that can
mimic symptoms of ADHD include academic misplacement, either under or over
stimulating, stress responses to family conflict or disorganized home life, or age
appropriate behaviors in active children.
7. A thorough review of health status and physical exam should be requested and reviewed to
rule out medical issues, such as impaired vision or hearing, allergies or environmental
sensitivities, hyperthyroidism, malnutrition, seizures or head injury, genetic disorders and toxic
brain syndromes, e.g. in utero alcohol or lead exposure.
8. Consider cultural factors that influence diagnosis and treatment. In cultures that emphasize
orderliness and adherence to strict behavioral expectations, ratings of hyperactivity may be
higher [i.e., seen as more deviant] than when the same behaviors are rated by individuals from
cultures that have less rigid behavioral standards for children. It is important to recognize that
perceptions of hyperactive, inattentive, and disruptive behaviors may be influenced by the
observer’s culture. When considering this diagnosis, the clinician should inquire about cultural
expectations or beliefs and should obtain observational data from multiple perspectives,
whenever possible.
Treatment Guidelines:
1. Focus treatment planning on specific areas of functioning. Identify target behaviors based on
the client’s presentation (incomplete tasks, forgetfulness, behavioral disturbance, etc.), and
develop a plan that focuses on those specific behaviors. Be sure to emphasize the strengths of the
client and support systems.
2. Secondary difficulties including problems with academic/vocational issues, relationships,
poor self-esteem, anxiety, and depression should also be considered in treatment planning. Set
specific goals around secondary difficulties as well, for example increase independence in selfcare or work completion.
3. For children, ongoing collaboration, with parents and teachers, is an essential component of
treatment. Research on evidence based practices that include family involvement and parent
training have been found to be most effective. This includes providing support and education to
the primary adults in the child’s life and establishing a behavioral management program that
ensures consistency between home and school environments. The clinician can help establish
communication methods between home and school, such as through a daily report card (see
http://www.addresources.org/?q=node/611 for more information). Realistic and measurable goals
with clear plans for follow-up should be established.
4. Medication can be one treatment foundation, particularly when behavioral therapy alone is
not working. Pharmacologic treatment, such as stimulant medication, is highly effective in
managing core symptoms. Communicate with the prescriber about any side effects your client
reports, such as weight loss due to decreased appetite. See attached medication algorithm.
Children and young adolescents should not be responsible for administering their own
medications due to impulsivity and disorganization; however, this can be encouraged in
older adolescents.
Revised 6/1/2012
5. Behavior therapy is recommended as the primary psychosocial intervention. See resource
list for more information on behavioral interventions.
For children: parents and, where appropriate, teachers can be trained in specific
behavior modification techniques for improving behavior including increased structure
and environmental changes (such as classroom seating or study area), use of positive
reinforcements and consequences, and reduction of distractions.
For adolescents and adults: encourage structuring their environments and schedules.
6. Psychoeducation and support about the nature of ADHD, its effects on learning, self-esteem,
behavior, social skills and family functioning should be provided. Improvements are sustainable
with ongoing interventions and supports. Intensity of ongoing intervention varies by client.
For children: educate parents and when possible, teachers, about the effects of ADHD.
Parent or support groups (e.g. CHADD, http://www.chadd.org/ ) can be an effective
mode for education, providing the added benefit of normalizing family experiences.
Provide developmentally appropriate education for the child.
7. Continue assessment of drug and alcohol use throughout treatment. Be aware of possible
misuse of stimulant medications, either overusing or giving/selling to others.
8. Assess responsiveness to treatment plan periodically, and adjust as needed. If treatment does
not obtain positive results, it may be necessary to reevaluate the original diagnosis, co-existing
symptoms and treatment goals.
Adapted from American Academy of Child and Adolescent Psychiatry (2007). Practice
parameters for the assessment and treatment of children, adolescents, and adults with ADHD.
Journal of the American Academy of Child and Adolescent Psychiatry, 36 (10, Suppl.), 85S121S American Academy of Pediatrics (2000). Clinical practice guidelines: Diagnosis and
evaluation of the school-aged child with ADHD. Pediatrics, 105 (5), 1158-1170.
Resources for Professionals
Barkley, R. (1997). Defiant Children: A Clinician’s Manual for Parent Training (Second
Edition). New York: Guilford Press.
Barkley, R (2005). Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and
Treatment (Third Edition). New York: Guilford Press.
DuPaul, G. & Stoner, G. (1994). ADHD in Schools: Assessment and Intervention Strategies.
New York: Guilford Press.
Revised 6/1/2012
ADHD Medication Algorithm (Adults & Youth) *
* Adopted from Texas Medication Algorithm – ADHD (2006)
Additional Notes:
Combining stimulants and alpha agonists for insomnia is a frequent choice.
ADHD with Tics Medication Algorithm *
*Adopted from Texas Medication Algorithm – ADHD (2006)
Attention Deficit/Hyperactivity Disorder: Tips for Adults
Developed in collaboration with the mental health centers of NBHP and FBHP & the Client and Family Advisory Board
1. Participate fully in your treatment. Be actively involved in setting your individual goals, treatment
plan and attending appointments. Practice the skills and techniques you learn in treatment to address and
manage your symptoms. You can be hopeful about managing your symptoms. Research has shown that
interventions and lifestyle changes for ADHD are quite effective in reducing symptoms.
2. Ask questions. Ask your mental health provider to explain ADHD, treatment alternatives, and
suggestions on how you can take charge of your symptoms.
3. Be alert to your symptoms. Many adults with ADHD have additional emotional difficulties, such as
depression, anxiety, difficulties with work or relationships, and low self-esteem as a result of living and
coping with ADHD. These difficulties can be treated if they are recognized. Communicate any concerns
you may have about these symptoms with your treatment providers so you can get the help you need.
4. Create support through family, friends and peers. Ask them for feedback about how they think you are
doing with managing symptoms and how symptoms might affect your relationships. Ask your mental
health provider for information about online or peer support options such as Children & Adults with
ADHD.
5. Care about yourself. Establish a healthy lifestyle that includes adequate sleep, good nutrition and
regular physical activity. A healthy life style will help you regulate your energy level and ability to
concentrate. See your Primary Care Provider (PCP) regularly and if you don’t have one ask your Care
Coordinator/Case Manager for help in obtaining one.
6. Remember, alcohol and illegal drugs can worsen symptoms of ADHD. Adults with ADHD are at risk
of abusing drugs and alcohol as a way of self-medicating. Be sure to tell your therapist or prescriber if
this is a struggle for you.
7. Take ADHD medications as prescribed. Talk with your prescriber if you have questions about your
medication, especially if you are having uncomfortable side effects or trouble remembering to take the
medications regularly. They can work with you to come up with solutions to these issues.
8. Create a routine/structure for yourself. Use your phone, planner, or calendar to stay on track with your
goals, appointments, etc. Create lists for remembering daily tasks, and use other types of reminders to
help you organize your day. There are a number of applications available for smart phones or computers
to help manage symptoms of ADHD and get organized.
9. Learn about ADHD and how you can learn strategies for coping effectively with symptoms. Ask for
written materials and read information on the Internet or from the library (see the resources list below).
Revised 5/1/2012
Attention Deficit/Hyperactivity Disorder: Tips for Adults
Developed in collaboration with the mental health centers of NBHP and FBHP & the Client and Family Advisory Board
Resources for Clients and Families
American Academy of Pediatrics http://www.aap.org/healthtopics/adhd.cfm
ADDitude: Living well with attention deficit http://www.additudemag.com/
National Institute of Mental Health (1-800-421-4211 or http://www.nimh.nih.gov/health/publications/attentiondeficit-hyperactivity-disorder/complete-index.shtml)
Attention Deficit Disorder Resources http://www.addresources.org/?q=node/253
Children and Adults with ADHD (CHADD) www.chadd.org
https://www.achievesolutions.net/achievesolutions/en//Home.do
Books:
Taking Charge of Adult ADHD by Russell Barkley, Ph.D.
Journeys Through ADDulthood by Sari Solden
The Gift of Adult ADD by Lara Honos-Webb, Ph.D.
You Mean I’m not Lazy, Stupid, or Crazy?! By Kate Kelly and Peggy Ramundo
Revised 5/1/2012
Attention Deficit/Hyperactivity Disorder: Tips for Parents
Developed in collaboration with the mental health centers of NBHP and FBHP & the Client and Family Advisory Board
1. Learn about your child’s symptoms. Ask for written materials and read information on the Internet
or from the library (see resource list below). Often children with ADHD have other emotional or
developmental difficulties that can be treated if recognized, including symptoms of depression,
anxiety, learning disabilities, and anger problems. Not all children with ADHD have the same
symptoms, e.g. it is not uncommon for children with ADHD to have periods of sustained attention
and interest in video games or watching television.
2. Participate in your child’s treatment. ADHD is not caused by parents, but parents play a big role in
helping children manage their symptoms and improve outcomes. Be involved in creating treatment
goals and assist in practicing skills that your child is learning in treatment.
3. Communicate with teachers, prescriber and therapist. Communicate regularly with your child’s
teacher to stay aware of behaviors and progress at school. Be an advocate for your child. Be familiar
with your child’s treatment and school interventions, including strategies that worked and those that
didn’t. You may be asked to provide copies of school or treatment records to coordinate your child’s
care.
4. Practice skills you learn for working with your child. Behavior modification techniques used by
parents can be very helpful to children, if parents continue to use them. Give praise and attention to
positive behaviors and use consistent, appropriate consequences. Talk to your child’s therapist if
certain strategies don’t seem to work so you can modify and improve them.
5. Take care of your child’s physical health. Tell your child’s PCP about treatment your child is
receiving for ADHD, including medications, and ask about ruling out possible medical conditions.
Children with ADHD may have sleep difficulties. Encourage a healthy nutritional and physical
activity routine to promote sleep and regulate mood and energy level.
6. If your child has a confirmed food allergy, changing their diet has been found to be helpful. If
there’s no allergy, there is no evidence that diet modifications will affect symptoms.
7. Be in charge of your child’s medication. Talk with the prescriber about side effects and potential
misuse of medications by your child or others. Parents should have appropriate medication oversight.
Monitor your child taking medication; request school staff do the same. Keep medication out of your
child’s reach. Pay attention to side effects and reactions to medication (keep a record) and
communicate these to the prescriber.
8. Create a routine/structure. Encourage your child to use a phone, planner, or calendar to stay on
track with daily activities, goals, etc. Make sure your child has a study area that is free from
distractions and help them maintain organization in this area.
9. Get support for yourself from friends, family, or other parents of children with ADHD. Parenting a
child with ADHD can be challenging and frustrating. Ask your therapist about online or community
support groups such as Children and Adults with ADHD (CHADD).
10. Encourage independence. Your child can learn to manage their symptoms and can take a more
active role in self-management over time.
Revised 5/1/2012
Attention Deficit/Hyperactivity Disorder: Tips for Parents
Developed in collaboration with the mental health centers of NBHP and FBHP & the Client and Family Advisory Board
Resources for Clients and Families
American Academy of Pediatrics http://www.aap.org/healthtopics/adhd.cfm
ADDitude: Living well with attention deficit http://www.additudemag.com/
National Institute of Mental Health (1-800-421-4211 or http://www.nimh.nih.gov/health/publications/attentiondeficit-hyperactivity-disorder/complete-index.shtml)
Children and Adults with ADHD (CHADD) www.chadd.org
https://www.achievesolutions.net/achievesolutions/en//Home.do
Barkley, R. (2000). Taking Charge of ADHD: The Complete Authoritative Guide for Parents. New York:
Guilford Press.
Nadeau, K., Dixon, E. & Rose, J. (1998). Learning to Slow Down and Pay Attention: A Book for Kids About
ADD. Washington, DC: Magination Press.
Quinn, P., Stern, J. & Russell, N. (1998). The ‘Putting on the Brakes’ Activity Book for Young People with
ADHD. Washington, DC: Magination Press.
Quinn, P., Stern, J. & Russell, N. (2001). Putting on the Brakes: Young People’s Guide to Understanding
Attention Deficit Hyperactivity Disorder. Washington, DC: Magination Press.
Revised 5/1/2012
Attention Deficit/Hyperactivity Disorder: Tips for Teens
Developed in collaboration with the mental health centers of NBHP and FBHP & the Client and Family Advisory Board
1. Participate in your treatment. You are the expert about yourself. Be actively involved in
setting your individual treatment goals and attending appointments. Practice the skills you
learn in treatment. Since most teens still live with their parents or other adults, treatment often
includes these adults. Let your therapist and/or prescriber know if you want some time to talk
with them alone.
2. Ask questions. Ask your therapist and/or prescriber to explain if they say things you don’t
understand, or if you have questions about ADHD and your treatment. Write down questions
ahead of time and bring them to appointments.
3. Talk to your school counselors or teachers about things that help you learn, such as where
you sit in the classroom, extra time or help on assignments; or you can say things like “it’s
easier for me when there’s not so much noise.”
4. Pay attention to your feelings. A lot of teens with ADHD have feelings that are hard to deal
with, like feeling anxious about school or having low self-esteem. All teens struggle with peer
pressure. This can be harder to resist when you feel anxious or don’t feel good about yourself.
Surround yourself with positive people. You can ask to talk confidentially with your therapist
if you are worried about any of these things.
5. Get support from family, friends and peers. You are not alone! There are teen support
groups where you can talk with other teenagers about how they deal with ADHD. Ask for
information about support groups in your community or online like Children and Adults with
ADHD (CHADD).
6. Care about yourself. Get enough sleep, proper nutrition and regular physical activity these
things can all help you control your energy and your ability to concentrate. Join an afterschool activity; this is a great way to use your energy, feel good about yourself and make
friends. Remember, alcohol and illegal drugs often complicate symptoms of ADHD and make
life more difficult.
7. Take ADHD medications as prescribed. Talk to your parents or prescriber if you have any
questions about your medications or if you have uncomfortable side effects. Ask your parents
or other close adult to help if you are having trouble remembering to take the medications.
8. Create a routine/structure for yourself. Use your phone, planner, or calendar to stay on
track with your goals, appointments, etc. Create lists for remembering daily tasks, and use
other types of reminders to help you organize your day. There are a number of applications
available for smart phones or computers to help manage symptoms of ADHD and get
organized.
9. Learn about ADHD and how people with ADHD learn to cope effectively with their
symptoms. Ask for written materials, and read information on the Internet or from the library
and see the resource list below.
Revised 5/1/2012
Attention Deficit/Hyperactivity Disorder: Tips for Teens
Developed in collaboration with the mental health centers of NBHP and FBHP & the Client and Family Advisory Board
Resources for Clients and Families
American Academy of Pediatrics http://www.aap.org/healthtopics/adhd.cfm
ADDitude: Living well with attention deficit http://www.additudemag.com/
National Institute of Mental Health (1-800-421-4211 or
http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/complete-index.shtml)
Children and Adults with ADHD (CHADD) www.chadd.org
https://www.achievesolutions.net/achievesolutions/en//Home.do
Quinn, P., Stern, J. & Russell, N. (1998). The ‘Putting on the Brakes’ Activity Book for Young People with
ADHD. Washington, DC: Magination Press.
Revised 5/1/2012
Trastorno por déficit de atención con hiperactividad: consejos prácticos para
padres de familia
Desarrollado en colaboración con los centros de salud mental de NBHP y FBHP y la Comisión consultiva del consumidor y
asuntos familiares
1. Aprenda sobre los síntomas de su hijo. Pida materiales escritos y lea información en Internet o de
la biblioteca (vea la lista de recursos disponibles abajo). Es común que niños que padecen del ADHD
(por sus siglas en inglés) tengan otros trastornos emocionales o de desarrollo que se pueden tratar si
se reconocen, incluyendo síntomas de depresión, ansiedad, dificultades de aprendizaje, y problemas
con controlar el enojo. No todos los niños con el ADHD tienen los mismos síntomas. Por ejemplo,
no es raro que niños con el ADHD tengan períodos de atención prolongados e interés en videojuegos
o mirar la televisión.
2. Participe en el tratamiento de su hijo. El ADHD no es causado por los padres, pero los padres
desempeñan un gran papel en ayudarles a sus hijos a controlar sus síntomas y mejorarse. Involúcrese
en crear metas para el tratamiento y ayúdele a su hijo a practicar y desarrollar las habilidades que está
aprendiendo en el tratamiento.
3. Comuníquese con los maestros, terapeutas y la persona que le prepara recetas. Comuníquese
regularmente con los maestros de su hijo para estar pendiente de cómo se comporta y progresa en la
escuela. Abogue por su hijo. Familiarícese con los tratamientos que recibe y cómo se ha involucrado
la escuela, incluyendo las estrategias que han funcionado y las que no. Puede que se le pida que
provea copias de expedientes escolares y del tratamiento que ha recibido para poder coordinar el
cuidado de su hijo.
4. Practique las habilidades que aprende su hijo para trabajar con su hijo. Técnicas de modificar el
comportamiento que utilizan los padres pueden ayudarles mucho a los niños, si los padres los siguen
utilizando. Elogie y preste atención a los comportamientos positivos y utilice castigos consistentes y
apropiados. Hable con el terapeuta de su hijo si ciertas estrategias no parecen funcionar para poder
modificarlas y mejorarlas.
5. Cuide la salud física de su hijo. Cuéntele al PCP de su hijo del tratamiento que está recibiendo para
ADHD, incluyendo los medicamentos, y pregúntele sobre cuáles condiciones médicas se pueden
eliminar de consideración. Niños con ADHD quizá tengan dificultad para dormir. Anime una rutina
con nutrición sana y actividad física para promover el sueño y regular el nivel de energía y el ánimo.
6. Si su hijo tiene una alergia a algún alimento confirmado, se ha encontrado que cambiarle la dieta
puede ayudar. Si no hay alergias, no hay evidencia que modificar la dieta afecte los síntomas.
7. Esté a cargo de los medicamentos de su hijo. Hable con la persona que prepara las recetas respecto
a efectos secundarios y el abuso de medicamentos por su hijo u otros. Los padres deben asegurarse
de vigilar de modo apropiado los medicamentos. Controle que su hijo tome el medicamento; pida que
el personal de la escuela haga lo mismo. Preste atención a los efectos secundarios y reacciones a los
medicamentos (mantenga un diario) y comuníquese con la persona que prepara las recetas.
8. Cree una rutina/estructura. Anímele a su hijo a usar un teléfono, una agenda, o calendario para
mantenerse al tanto de sus actividades diarias, metas, etc. Asegúrese que su hijo tenga un área para
estudiar libre de distracciones y ayúdele a mantener esta área organizada.
Revised 5/1/2012
Trastorno por déficit de atención con hiperactividad: consejos prácticos para
padres de familia
Desarrollado en colaboración con los centros de salud mental de NBHP y FBHP y la Comisión consultiva del consumidor y
asuntos familiares
9. Busque apoyo para usted mismo de amistades, familiares, u otros padres de jóvenes que padecen
del ADHD. Cuidar de un hijo con el ADHD puede ser un reto y frustrante. Pregúntele a su terapeuta
sobre grupos de apoyo en la red o en la comunidad como Niños y adultos con el ADHD- Children
and Adults with ADHD (CHADD).
10. Anime la independencia. Su hijo puede aprender a regular sus síntomas y, con el tiempo, cumplir un
papel más activo en auto-regularse.
Recursos para clientes y familias
American Academy of Pediatrics http://www.aap.org/healthtopics/adhd.cfm
ADDitude: Vivir bien con el trastorno de déficit de atención e hiperactividad http://www.additudemag.com/
National Institute of Mental Health (1-800-421-4211 or http://www.nimh.nih.gov/health/publications/attentiondeficit-hyperactivity-disorder/complete-index.shtml)
Niños y adultos con ADHD: Children and Adults with ADHD (CHADD) www.chadd.org
https://www.achievesolutions.net/achievesolutions/en//Home.do
Barkley, R. (2000). Taking Charge of ADHD: The Complete Authoritative Guide for Parents. New York:
Guilford Press.
Nadeau, K., Dixon, E. & Rose, J. (1998). Learning to Slow Down and Pay Attention: A Book for Kids About
ADD. Washington, DC: Magination Press.
Quinn, P., Stern, J. & Russell, N. (1998). The ‘Putting on the Brakes’ Activity Book for Young People with
ADHD. Washington, DC: Magination Press.
Quinn, P., Stern, J. & Russell, N. (2001). Putting on the Brakes: Young People’s Guide to Understanding
Attention Deficit Hyperactivity Disorder. Washington, DC: Magination Press.
Revised 5/1/2012
Trastorno por déficit de atención con hiperactividad: consejos prácticos para
adolescentes
Desarrollado en colaboración con los centros de salud mental de NBHP y FBHP y la Comisión consultiva del consumidor y
asuntos familiares
1. Participa en tu tratamiento. Tú eres el experto sobre ti mismo. Participa activamente en
establecer tus metas individuales para tu tratamiento y cumplir con tus citas. Practica las
habilidades que aprendas durante el transcurso de tu tratamiento. Ya que la mayoría de
adolescentes todavía vive con sus padres u otros adultos, el tratamiento frecuentemente
incluye a estos adultos. Avísale a tu terapeuta o a la persona que te prepara las recetas si
quieres un momento para hablar con ellos a solas.
2. Haz preguntas. Pídele a tu terapeuta y/o la persona que prepara tus recetas que te expliquen
si te dicen cosas que no entiendes, o si tienes preguntas sobre el ADHD y tu tratamiento.
Escribe las preguntas de antemano y llévalas a las citas.
3. Háblales a tus consejeros en la escuela o a tus maestros sobre cosas que te ayudan a
aprender, como dónde te sientas en la sala de clase, tiempo extra o ayuda en las asignaturas; o
puedes decir cosas como “es más fácil para mí cuando no hay tanto ruido.”
4. Presta atención a tus sentimientos. Muchos adolescentes con el ADHD tienen sentimientos
que son difíciles, como sentirse ansioso sobre la escuela o tener baja autoestima. Todos los
adolescentes luchan con la presión social de pares. Esto puede ser aún más difícil de resistir
cuando te sientes ansioso o no te sientes bien respecto a ti mismo. Rodéate de gente positiva.
Puedes pedir hablar confidencialmente con tu terapeuta si estás preocupado sobre cualquiera
de estos asuntos.
5. Recibe apoyo de familia, amigos y pares. ¡No estás solo! Hay grupos de apoyo en los
cuales puedes hablar con otros adolescentes sobre cómo ellos lidian con el ADHD. Pide
información sobre tales grupos en tu comunidad o en Internet como Niños y adultos con el
ADHD- Children and Adults with ADHD (CHADD).
6. Valórate a ti mismo. Dormir suficiente, comer comidas con nutrición apropiada y hacer
actividades físicas regularmente pueden ayudarte a controlar tu energía y tu habilidad para
concentrarte. Únete a alguna actividad extracurricular en la escuela; este es un modo
estupendo de usar tu energía, sentirte bien sobre ti mismo y hacer amigos. Recuerda, el
alcohol y las drogas ilícitas frecuentemente complican los síntomas del ADHD y te hacen la
vida más difícil.
7. Toma los medicamentos para el ADHD siguiendo la receta. Háblales a tus padres o a la
persona que prepara tus recetas si tienes alguna pregunta sobre tus medicamentos o si tienes
efectos secundarios incómodos. Pídeles a tus padres u otro adulto cercano que te ayude si
tienes problemas para recordar tomar tus medicamentos.
8. Crea una rutina/estructura para ti mismo. Usa un teléfono, una agenda, o calendario para
mantenerte al tanto de tus actividades diarias, metas, etc. Hazte listas para recordar tareas
diarias, y usa otros tipos de recordatorios para ayudarte a organizar tu día. Hay varias
aplicaciones para smartphone o computadora disponibles para ayudarte a controlar los
síntomas del ADHD y organizarte.
Revised 5/1/2012
Trastorno por déficit de atención con hiperactividad: consejos prácticos para
adolescentes
Desarrollado en colaboración con los centros de salud mental de NBHP y FBHP y la Comisión consultiva del consumidor y
asuntos familiares
9. Aprende sobre el ADHD y cómo la gente que padece del ADHD aprende a lidiar de modo
eficaz con sus síntomas. Pide materiales escritos, y lee información en la red o de la
biblioteca; también ve la lista de recursos abajo.
Recursos para clientes y familias
American Academy of Pediatrics http://www.aap.org/healthtopics/adhd.cfm
ADDitude: Vivir bien con el trastorno de déficit de atención e hiperactividad http://www.additudemag.com/
National Institute of Mental Health (1-800-421-4211 or
http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/complete-index.shtml)
Children and Adults with ADHD (CHADD) www.chadd.org
https://www.achievesolutions.net/achievesolutions/en//Home.do
Quinn, P., Stern, J. & Russell, N. (1998). The ‘Putting on the Brakes’ Activity Book for Young People with
ADHD. Washington, DC: Magination Press.
Revised 5/1/2012
Appendix A
Similarities and Differences: ADHD and Early Onset Bipolar Disorder
Revised from the works of By F. Russell Crites
Some characteristics of ADHD and Bipolar Disorder look the same, but have different motivations.
Others show the same type of behavior, but it is more or less intense in some way.
SYMPTOM
BREAKS THINGS:
ANGER:
REGRESSION:
ADHD
BIPOLAR
Breaks things carelessly or impulsively while playing (nonangry destructiveness);
Breaks things as a result of anger. He has severe temper
tantrums where he releases extreme amounts of physical and
emotional energy. Aggression towards others and physical
property damage sometimes occurs. May be cruel,
destructive, and sadistic.
Usually calms down in twenty to thirty minutes (maybe less). Anger may be trance-like or have OCD qualities. May
continue to feel/act angry for up to four hours or more.
Rarely regresses, e.g., displays disorganized thinking,
language, and body position.
FORGETS THE EVENT: Does not lose memory of events, except due to inattention.
Regresses and often has disorganized thinking, language and
body position during the episode. He may be clinging, display
social phobia, and experience bedwetting.
May lose memory of the tantrum or event.
TRIGGER EVENTS:
Typically triggered by a lack of structure or over-stimulation. Overreacts to limit-setting, is triggered by anxiety (look for
PTSD issues), new social situations, misattribution of motives,
or by sensory or emotional over-stimulation.
SLEEP:
May sleep 5-9 hrs. However, he will often be tired due to lack Has a decreased need for sleep (3-6 hrs), e.g., may stay up late
of good REM (rapid eye movement) sleep.
and get up early and not seem to have any bad effects.
SLEEPING and
WAKING UP:
Usually arouses quickly and attains alertness within minutes. Often stays up late, and is irritable upon early morning
However, they are tired and often do not get a good night
arousal. He may have slow arousal and have irritability, fuzzy
sleep…especially hyperactive-impulsive students.
thinking, or somatic complaints when he gets up (may last for
a few hours).
Seems to wear himself out and get tired during the day (this Not usually tired during the day.
may be a medication issue).
May destroy the bed covers, but he does not have excessive Often has severe nightmares or night terrors. Themes of
nightmares or night terrors.
explicit gore, death, harm, and bodily mutilation are often
reported, and may carry forward to wakeful states.
GETTING TIRED:
NIGHTMARES:
Appendix A
SYMPTOM
REALITY and
JUDGMENT:
MOOD SWINGS:
SELF ESTEEM:
MISBEHAVIOR:
CONTROL ISSUES:
OPPOSIONAL
DEFIANCE:
LYING and BLAMING:
ENTITLEMENT:
ADHD
BIPOLAR
Can see reality for what it is. He can make good judgments,
but he just doesn’t take the time to do so.
Is grandiose and believes that he can do things that he can’t
do (impaired judgment). Doesn’t think things through, and
even if he does, it is often flawed thinking.
Will not have significant shifts in mood, e.g., depressed to
manic.
Low, resulting from ongoing performance difficulties.
Will often have mood shifts during the day, or at the least
during the week.
Low, resulting from inherent unpredictability of mood.
Grandiose or expansive moods could mask low esteem.
Misbehavior is often accidental and usually caused by
inattention, impulsivity, or over-activity.
Will intentionally provoke or misbehave. Often misattributes
the intent of others and may attack. Some are seen as the
‘bully on the playground’.
Desire more to seek approval. Gets into trouble due to
Intermittent desire to please others, but tends to push limits
inability to complete tasks.
and relish power struggles. Expert hasslers.
Demonstrates argumentativeness but will relent with show of Usually overtly and prominently defiant, at times passive
authority, and are redirectable. Short attention span allows aggressive, often not relenting to authority. Tend to insist on
them to "let go" more easily.
getting own way.
Self-protective mechanism to avoid immediate adverse
Enjoys "getting away with it," and to avoid immediate adverse
consequences.
consequences. Grandiosity contributes to disbelief/denial
they caused something to go wrong.
Overwhelming need for immediate gratification and acts
Expansive and grandiose mood creates belief they deserve
impulsively.
special treatment. Oriented to "now" or the near future.
CONSCIENCE
DEVELOPENT:
PEER
RELATIONSHIPS:
MOTIVATION:
Capable of demonstrating remorse when things calm down.
Close to developmental age.
Makes friends easily, but may have problems keeping them
due to immaturity.
Less resourceful - more adult dependent. Okay starters but
poor finishers.
Limited conscience development, dependent on mood and
caregiver's skills and abilities.
Can be charismatic or depressed, depending on mood.
Conflicts are common due to controlling nature.
Grandiose - believe they are resourceful, gifted, creative. Selfdirected, highly variable energy and enthusiasm.
ANXIETY:
Uncommon, unless performance-related.
DEVELOPMENT and
LEARNING
Normal or slow development. Learning disabilities are
somewhat common.
Emotionally wired. High potentials for anxiety, fears, and
phobias. Somatic symptoms common, needle phobia, and
some dissociation possible.
Precocious development, especially cognitive and language
skills. LD problems are not common, unless comorbid with
ADHD or related with disabling mood swings.
Appendix A
SYMPTOM
RACING THOUGHTS:
ADHD
BIPOLAR
Has racing thoughts that are fragmented; bits and pieces of
hundreds of things that distract or draw his attention.
Often has racing thoughts. Usually gives concrete description
of thoughts, e.g., “I need a stoplight.” "My thoughts broke the
speed limit.” Can tell about a specific ‘topic’ he is racing
about. Speech is usually goal directed.
RISK TAKING:
May engage in behavior that can lead to harmful
consequences without being aware of the danger. Engages
in these behaviors to satisfy a need for increased stimulation,
but is oblivious to the dangers/consequences.
Is often a risk or sensation seeker. Engages in risk behaviors
to satisfy a need for control. Some intentional dangerous
behaviors despite knowledge of potentially harmful
consequences.
FIRE SETTING:
Play with matches out of curiosity, nonmalicious.
SEXUAL BEHAVIORS:
Intrigued with matches and fire setting, and can have
malicious intent.
Often immature for his age. As a result, sexuality comes along Tends to have strong early sexual interest and precocious
at a slower pace because of psychosocial or developmental behavior. He may be sexually inappropriate for age e.g., use
delays.
explicit sexual language, sexual pictures
REALITY TESTING:
Usually does not have psychotic symptoms or reveal a loss of May exhibit gross distortions in perception of reality or in the
contact with reality. Sometimes is clueless about the context interpretation of emotional events. Can be delusional.
due to inattention, but is not delusional.
ELATION:
Will be elated (Giggle, excited, extremely ‘happy’) when
special events occur.
May be elated for no apparent reason, e.g., giggling in the
classroom when peers are not, laughing for no reason, etc. At
the same time he may be sensitive or easily irritated.
RESTLESSNESS:
May have restless tension as seen in an inability to keep his
legs, hands, etc. still. This occurs all day long.
IMPULSIVITY:
Can be impulsive and react to his environment, not so much
his inner turmoil.
Will have the same problem with restlessness, but it may cycle
through the day, often getting worse at night (depends on
type of bipolar).
Will be impulsive due to a swing in moods. If hypomanic,
judgment fades. If depressed he may have a need to find a
way to reduce his depression or energize himself.
INATTENTION and
POOR FOCUS:
Will probably be inattentive or distractible all day long, every May be inattentive for a time and then become attentive as
day of the week (pending medication).
he pulls out of his depression. If he goes too far into the manic
side he will lose attention again. Attention is often
cyclical…may be hour by hour or day by day.
Appendix A
SYMPTOM
SELF CENTERED:
SUICIDAL THINKING
and SUICIDE:
INJURY TO SELF OR
OTHERS:
RAGES:
TALKS A LOT:
ADHD
BIPOLAR
May be self-centered, but is usually so because of a sense of
frustration at being unable to focus.
Seems to be unable to see other’s perspective in a situation.
He will do whatever is necessary to justify his position. Very
irritable.
May talk of suicide as a control issue. Usually there is no
May have a morbid fantasy about death, hurting others, etc.
intention, plan, etc. for follow through.
Suicide is the leading cause of death of people with Bipolar
Disorder.
Would rarely intentionally hurt self or others. If something
Will intentionally hurt self or others with purpose. This
were to occur it would be more of an accident due to
purpose will often seem to be malevolent or grandiose in
inattention.
nature, i.e., creative ways to hurt someone who has offended
him.
Will have non-directive meltdowns. They are usually short in Will go into a rage and direct it at a person, or some available
duration.
target. It is deliberate and intentional in nature. He may
attack those in authority.
May speak out of turn (even have a lot to say), but can be
When manic, may have a verbal outpouring, speaking without
redirected to task.
stopping even when someone tries to stop him.
OPTIMAL
ENVIRONMENT:
Moderate tendencies as coping mechanisms for low self
esteem.
Low stimulation and stress. Support and structure. Identify
learning disability components.
Very strong tendencies in attempt to enhance mood or
reduce manic/dysphonic moods.
Clear and assertive, balance of limits with encouragement and
negotiation. Treatment team works together.
PARENTING
TECHNIQUES:
Support, encouragement, and redirection are most
beneficial.
Most things do not work for the long term until correctly
diagnosed and treated with medications and therapy.
MEDICATION
RESPONSE:
Responsive to stimulants and other ADHD medications. Not
responsive to Lithium or antipsychotic medications.
Responsive to Lithium, anticonvulsives, antipsychotics,
anxiolytics. Stimulants may trigger aggression or mania.
PROGNOSIS:
Good to excellent with appropriate medical treatment,
ancillary therapies, and educational accommodations.
Fair to good with appropriate treatment. Possible times of
regression/relapse even with appropriate treatment.
SUBSTANCE ABUSE:
Appendix B
Psychiatric Disorders to Consider in the Differential Diagnosis of ADHD in Adults
H. Russell Searight, Ph.D., John M. Burke, Pharm.D., and Fred Rottnek, M.D., Family Medicine of St. Louis Residency Program, St. Louis, Missouri. Am Fam Physician. 2000 Nov 1;62(9):2077-2086.
Patients with a range of psychiatric conditions may emphasize difficulty with concentration, attention or short-term memory when they describe their
problems. It is important to consider the historical basis of the symptoms and exclude other psychiatric conditions, most of which are actually more
prevalent than ADHD among adults. Major depression and substance abuse, also commonly accompany adult ADHD.
Importantly, most adults with ADHD do not have a "pure" form of the disorder. Comorbidity is more likely to be the rule than the exception. It is not
clear whether these comorbid psychiatric conditions are a psychological effect of preexisting ADHD or are simply associated with ADHD
Psychiatric disorder
Features shared with ADHD
Distinctive features
Major Depression
Subjective report of poor concentration, attention Enduring dysphoric mood or anhedonia; sleep and
and memory; difficulty with task completion
appetite disturbance
Bipolar Disorder
Hyperactivity, difficulty with maintaining attention Enduring dysphoric or euphoric mood; insomnia;
and focus; mood swings
delusions
Generalized Anxiety
Fidgetiness; difficulty concentrating
Exaggerated apprehension and worry; somatic
symptoms of anxiety
Substance Abuse or Dependence Difficulties with attention, concentration and
memory; mood swings
Pathologic pattern of substance use with social
consequences; physiologic and psychological tolerance
and withdrawal
Personality Disorder (particularly Impulsivity; affective lability
Borderline or Antisocial)
Arrest history (antisocial personality); repeated selfinjurious or suicidal behavior (borderline personality);
lack of recognition that behavior is self-defeating
Appendix C
Differential Diagnostic Tips for Distinguishing Other Mental Disorders from ADHD (R. A. Barkley)
ADHD, Predominantly Inattentive Type
Lethargy, staring, and daydreaming more likely than in ADHD,
Combined Type
Sluggish cognitive tempo/slow information processing
Lacks impulsive, disinhibited, or aggressive behavior
Possibly greater family history of anxiety disorders and learning
disabilities
Makes significantly more errors in academic work
No elevated risk for Oppositional Defiant or Conduct Disorder
Oppositional Defiant Disorder and Conduct Disorder
Lacks impulsive, disinhibited behavior
Defiance primarily directed toward mother initially
Able to cooperate and complete tasks requested by others
Lacks poor sustained attention and marked restlessness
Resists initiating demands, whereas ADHD children may initiate
but cannot stay on task
Often associated with parental child management deficits or
family dysfunction
Lacks neuromaturational delays in motor abilities
Learning Disabilities
Has a significant IQ/achievement discrepancy (+1 standard
deviation)
th
Places below the 7 percentile in an academic achievement skill
Lacks an early childhood history of hyperactivity
Attention problems arise in middle childhood and appear to be
task or subject specific
Not socially aggressive or disruptive
Not impulsive or disinhibited
Anxiety/Affective Disorders
Likely to have a focused not sustained attention deficit
Not impulsive or aggressive; often overinhibited
Has a strong family history of anxiety disorders
Restlessness is more like fretful, worrisome behavior not the
“driven,” inquisitive, or overstimulated type
Lacks preschool history of hyperactive, impulsive behavior
Not socially disruptive; typically socially reticent
Asperger’s Syndrome, Schizotypal Personality Disorder
Show oddities/atypical patterns of thinking not seen in ADHD
Peculiar sensory reactions
Odd fascinations and strange aversions
Socially aloof, schizoid, disinterested
Lacks concern for personal hygiene/dress in adolescence
Atypical motor mannerisms, stereotypies, and postures
Labile, capricious, unpredictable moods not tied to reality
Poor empathy, cause–effect perception,
Poor perception of meaningfulness of events
Juvenile-Onset Mania or Bipolar I Disorder
Characterized by severe and persistent irritability
Depressed mood exists more days than not
Irritable/depressed mood typically punctuated by rage outbursts
Mood swings often unpredictable or related to minimal events
Severe temper outbursts and aggression with minimal
provocation (thus, ODD is often present and severe)
Later onset of symptoms than ADHD (but comorbid early ADHD is
commonplace)
Press of speech and flight of ideas often present
Psychotic-like symptoms often present during manic episodes
Family history of Bipolar I Disorder more common
Expansive mood, grandiosity of ideas, inflated self-esteem,
hypersexuality often seen in adults with Bipolar Disorder are
sometimes present though not as well formed; children may have
the dysphoric type of disorder however
Requires that sufficient symptoms of Bipolar Disorder be present
after excluding distractibility and hyperactivity (motor agitation)
from Bipolar symptom list in DSM-IV before granting Bipolar I
diagnosis to a child with symptoms of ADHD
Suicidal ideation is more common in child (and suicide attempts
more common in family history