13 Children are often referred for diagnosis and treatment because of poor academic performance, difficulty making friends, or low self-esteem (functional impairments) rather than because they cannot remain seated or they lose things or interrupt others (ADHD symptoms). Patients with ADHD are most often referred for treatment because of dysfunction in familial, social, emotional, academic, and occupational roles rather than because of ADHD symptoms.
#AIM EXECUTIVE FUNCTION TREATMENT MANUAL#
7-10 However, assessment of treatment response in patients with ADHD has generally been limited to narrowly focused measures of ADHD symptoms as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision ( DSM-IV-TR), 11 with relatively little attention to other relevant outcome domains. Pharmacologic and behavioral therapy can be effective treatments for ADHD, 3-6 as reflected in ADHD treatment guidelines. Epstein, PhD, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, ML-10006, Cincinnati, OH 45229-3039 ( estimated 9.5% of children aged 4 to 17 years 1 and 4.4% of adults 2 in the United States meet diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD).
Submitted: Decemaccepted May 11, 2012.Ĭorresponding author: Jeffery N. © Copyright 2012 Physicians Postgraduate Press, Inc. The authors recommend a potential battery and schedule of measures that could be used to more comprehensively assess treatment response in patients with ADHD. Validated rating scales exist for assessing these additional domains, but there has been minimal research evaluating the sensitivity of these instruments for detecting treatment response in pediatric and adult samples.Ĭonclusions: Assessment of treatment outcomes in ADHD should move beyond symptom assessment to incorporate measures of functioning, quality of life, adaptive skills, and executive function, especially when assessing long-term treatment response. Additional domains relevant for assessing treatment response among children and adults with ADHD include functional impairment, quality of life, adaptive life skills, and executive function. Results: The vast majority of studies assessing ADHD treatments have measured treatment response using ADHD symptom measures. Study Selection: Articles found through this search were then selected based on relevance to the topic area no specific quality criteria were applied. It’s important to think about the development of specific executive skills, and when and how we teach these skills to our children - especially children with ADHD, who will need extra help to master them.Objective: To review measures used to assess treatment response in patients with attention-deficit/hyperactivity disorder (ADHD) across the life span.ĭata Sources: Keyword searches of English-language articles in the PubMed database up to and including the May 4, 2011, index date were performed with the search strings (1) ( attention deficit disorder with hyperactivity OR ADHD) AND ( outcome assessment OR adaptation of life skills OR executive function ) and (2) ( attention deficit disorder with hyperactivity OR ADHD) AND ( function OR functioning OR quality of life ). In middle school, a nuanced understanding of priorities and time budgeting should emerge.įor parents and teachers, an understanding of the developmental track of executive functioning can provide a sort of map or set of bars to aim for as we help our kids grow. In 4th or 5th grade, more complex projects involving research, detailed planning and drafts should be achievable. In 2nd or 3rd grade, kids should reliably bring home necessary homework materials and be able to form a coherent paragraph. Professionals have developed scales to measure how well a child can perform the various functions - whether there are four, five, six, or more - which allow experts to identify where a child needs the most help, and how a child’s more robust skills can be tapped to compensate for problem areas.Īt home and at school, day-to-day tasks can indicate the development of executive function - or that a child needs help nurturing them. The complex set of symptoms we see in children with ADHD - deficits in a child’s ability to concentrate, stay on task, and self-regulate - can be broken down into these distinct functions, each of which should be developing through a child’s middle and high school years and even into young adulthood.Īpplying the concept of executive functioning to ADHD can improve treatment by making the targets of intervention more specific, and providing a better understanding of an individual child’s strengths and weaknesses. Barkley says, executive functions are a set of neuropsychological processes used to sustain problem solving toward a goal. The concept of executive function is really a way to understand how the brain works to solve problems and plan for the future.
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