**Meet the editor**

Dr Jill M. Norvilitis PhD is a Professor of Psychology at Buffalo State College in Buffalo, NY. She earned her undergraduate degree in psychology from Hope College in Holland, Michigan and her MA and PhD in Clinical Psychology from Wayne State University in Detroit, Michigan. In 2010, she was recognized with the SUNY Chancellor's Award for Excellence in Teaching. Dr.

Norvilitis is a Clinical Psychologist who specializes in behavior disorders of childhood. Her research focuses on predictors of social and academic adjustment among college students with Attention Deficit Hyperactivity Disorder (ADHD) and perceptions of ADHD cross-culturally. She is the author of over 30 journal articles, book chapters, and edited volumes and she has given over 80 conference and invited presentations.

Contents

**Preface IX** 

**Part 1 Treatment Considerations 1** 

Somnath Banerjee

Chapter 3 **Comorbidity in ADHD:** 

Chapter 1 **ADHD in Children and Adolescents: A Good Practice Guidance 3** 

Chapter 2 **ADHD and Comorbid Conditions 25** 

Nitin Patel, Mita Patel and Harsha Patel

**A Neuropsychological Perspective 47** 

**Part 2 Psychopharmacology: Mechanisms and Effects 89** 

**of Stimulants: Dopamine and ADHD 91**  Paul E.A. Glaser and Greg A. Gerhardt

**Drug Reactions Patterns of Psychostimulants Among Danish Children and Adolescents 111** 

**/Hyperactivity Disorder (ADHD) Enhance Cognition? 125** 

**Comparative Study from the Farmacological Treatment 157** 

Jose Armando Vidarte Claros and Consuelo Velez Alvarez

Chapter 4 **ADHD and Sleep Problems in Children 61**  Elizabeth Hastings and Barbara T. Felt

Chapter 5 **The Neuropsychopharmacology** 

Chapter 6 **Trends in the Prescribing and Adverse** 

Lise Aagaard and Ebba Holme Hansen

Chapter 7 **Do Stimulant Medications for Attention-Deficit** 

Claire Advokat and Christine Vinci

Chapter 8 **Motor Skills in Children with ADHD:** 

Julio César Flores Lázaro and María Alejandra Salgado Soruco

## Contents

#### **Preface XI**

	- **Part 2 Psychopharmacology: Mechanisms and Effects 89**
	- **Part 3 Non-Medication Interventions 193**
	- **Part 4 EEG Biofeedback 247**

## 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 neuropsychologicallybased 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.

Preface XI

The final section of the book explores the fairly new field of neurofeedback. Neurofeedback, which uses quantitative EEG in biofeedback training, is a controversial technique. Critics point to the lack of controlled research on the topic, but it remains popular with practitioners and clients. Grants investigating the technique are currently funded by the National Institutes of Health. Clearly, more research on this technique is needed and, in that spirit, three chapters here address neurofeedback. Chapter 14, "QEEG Characteristics and Biofeedback Modalities in Children with ADHD," describes the use of QEEG in the diagnosis of ADHD, with results from a study highlighting the differences among subgroups of the disorder. The chapter also provides a brief overview of neurofeedback for 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 protocols. Chapter 16, "The Effect of Psycho-Educational Therapy on Electroencephalographic Biofeedback Scores in Attention Deficit Hyperactivity Disorder," reports the results of a study examining the effect of a combination of neurofeedback and a cognitive-behavioral academic intervention. They found that a 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. I hope that the chapters spark new thoughts and, perhaps, debates.

This book is the result of the work of many individuals. I am particularly grateful for the assistance of Ms. Adriana Pecar and Mr. Igor Babic for their assistance in coordinating this book. I also thank all of the authors who contributed to this volume.

Barkley, R. A., Duncan, M., Loney, J., Milich, R., Werry, J., Cunningham, C….Hay, D.

Polanczyk, G., Silva de Lima, M., Lessa Horta, B., Biederman, J., & Rohde, L. A. (2007).

Timimi, S., Moncrieff, J., Jureidini, J., Leo, J., Cohen, D., Whitfield, C…White, R. (2004).

*and Family Psychology Review, 7,* 65-69.

*and Family Psychology Review, 7,* 59-63.

analysis. *American Journal of Psychiatry, 164, 6,* 942-948.

(2004). Critique or misrepresentation? A reply to Timimi et al. *Clinical Child* 

The worldwide prevalence of ADHD: A systematic review and metaregression

A critique of the International Consensus Statement on ADHD. *Clinical Child* 

**References** 

**Jill M. Norvilitis** 

USA

Department of Psychology, Buffalo State College, Buffalo, NY 14222,

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 nonmedication 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.

The final section of the book explores the fairly new field of neurofeedback. Neurofeedback, which uses quantitative EEG in biofeedback training, is a controversial technique. Critics point to the lack of controlled research on the topic, but it remains popular with practitioners and clients. Grants investigating the technique are currently funded by the National Institutes of Health. Clearly, more research on this technique is needed and, in that spirit, three chapters here address neurofeedback. Chapter 14, "QEEG Characteristics and Biofeedback Modalities in Children with ADHD," describes the use of QEEG in the diagnosis of ADHD, with results from a study highlighting the differences among subgroups of the disorder. The chapter also provides a brief overview of neurofeedback for 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 protocols. Chapter 16, "The Effect of Psycho-Educational Therapy on Electroencephalographic Biofeedback Scores in Attention Deficit Hyperactivity Disorder," reports the results of a study examining the effect of a combination of neurofeedback and a cognitive-behavioral academic intervention. They found that a 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. I hope that the chapters spark new thoughts and, perhaps, debates.

This book is the result of the work of many individuals. I am particularly grateful for the assistance of Ms. Adriana Pecar and Mr. Igor Babic for their assistance in coordinating this book. I also thank all of the authors who contributed to this volume.

> **Jill M. Norvilitis**  Department of Psychology, Buffalo State College, Buffalo, NY 14222, USA

#### **References**

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

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

The third section of the book moves from psychostimulants to an examination of nonmedication 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

between the two categories and the implications for treatment of ADHD.

changes in total cholesterol and lipoproteins.

for understanding this phenomenon.


**Part 1** 

**Treatment Considerations** 
