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'''Child & Adolescent Attention Deficit Hyperactivity Disorder (ADHD) - Clinical Assessment Portfolio (November, 2013)'' Section 1. Demographic Information - Provided in Table 1 Section 2. Diagnosis
 * 2.1 DSM 5 Diagnostic Criteria
 * 2.2 Diagnostic & Screening Instruments-Table 2 provides diagnostic efficiency information
 * 2.3 Recommended Diagnostic Interviews & Screening Instruments: CBCL, MINI-KID, and Conners Teacher Report can all be found at the
 * Finley Clinic

Section 3. Treatment
 * 3.1 Executive Summary of Evidence-Based Treatment for ADHD and Useful References for Treatment

Section 4. Process & Outcome Measures
 * 4.1 Severity and Outcome: Table of Clinically Significant Change Benchmarks (Table 4.1)
 * 4.2 Process measures
 * -CBCL Attention Problems Scale can be used to track changes in ADHD symptomotology throughout treatment and can be found
 * at Finley
 * -Daily Report Cards can be used to track changes in functional behaviors at home and at school for children with ADHD.
 * Instructions on how to create a daily report card are attached in Appendix 1

Section 5. Local Resources Appendix
 * Appendix 1: Instructions on how to create a Daily Report Card

Section 2.1: DSM 5 Diagnostic Criteria for ADHD DSM 5: Diagnostic Criteria for Attention Deficity/Hyperactivity Disorder A. A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by (1) and/or (2):
 * 1. Inattention: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level
 * and that negatively impacts directly on social and academic/occupational activities:
 * Note: The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or failure to understand tasks or instructions. For
 * older adolescents and adults (age 17 and older), at least five symptoms are required.
 * b. Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses
 * details, work is inaccurate).
 * c. Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy
 * reading).
 * d. Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction).
 * e. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses
 * focus and is easily sidetracked).
 * f. Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks; difficulty keeping materials and belongings in order;
 * messy, disorganized work; has poor time management; fails to meet deadlines).
 * g. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework; for older adolescents
 * and adults, preparing reports, completing forms, reviewing lengthy papers).
 * h. Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile
 * telephones).
 * i. Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts).
 * j. Is often forgetful in daily activities (e.g., doing chores, running errands; for older adolescents and adults, returning calls, paying bills, keeping
 * appointments).
 * Hyperactivity and impulsivity: Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with
 * developmental level and that negatively impacts directly on social and academic/occupational activities:
 * Note: The symptoms are not solely a manifestation of oppositional behavior, defiance, hostility, or a failure to understand tasks or instructions.
 * For older adolescents and adults (age 17 and older), at least five symptoms are required.
 * a. Often fidgets with or taps hands or feet or squirms in seat.
 * b. Often leaves seat in situations when remaining seated is expected (e.g., leaves his or her place in the classroom, in the office or other workplace,
 * or in other situations that require remaining in place).
 * c. Often runs about or climbs in situations where it is inappropriate. (Note: In adolescents or adults, may be limited to feeling restless.)
 * d. Often unable to play or engage in leisure activities quietly.
 * e. Is often “on the go,” acting as if “driven by a motor” (e.g., is unable to be or uncomfortable being still for extended time, as in restaurants,
 * meetings; may be experienced by others as being restless or difficult to keep up with).
 * f. Often talks excessively.
 * g. Often blurts out an answer before a question has been completed (e.g., completes people’s sentences; cannot wait for turn in conversation).
 * h. Often has difficulty waiting his or her turn (e.g., while waiting in line).
 * i. Often interrupts or intrudes on others (e.g., butts into conversations, games, or activities; may start using other people’s things without asking or
 * receiving permission; for adolescents and adults, may intrude into or take over what others are doing). Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years.


 * Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (e.g., at home, school, or work; with friends or relatives;
 * in other activities).
 * There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning.
 * The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another
 * mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal).
 * Specify whether:
 * 314.01 (F90.2) Combined presentation: If both Criterion A1 (inattention) and Criterion A2 (hyperactivity-impulsivity) are met for the past 6 months.
 * 314.00 (F90.0) Predominantly inattentive presentation: If Criterion A1 (inattention) is met but Criterion A2 (hyperactivity-impulsivity) is not met
 * for the past 6 months.
 * 314.01 (F90.1) Predominantly hyperactive/impulsive presentation: If Criterion A2 (hyperactivity-impulsivity) is met and Criterion A1 (inattention)
 * is not met for the past 6 months.
 * Specify if:
 * In partial remission: When full criteria were previously met, fewer than the full criteria have been met for the past 6 months, and the symptoms still
 * result in impairment in social, academic, or occupational functioning.
 * Specify current severity:
 * Mild: Few, if any, symptoms in excess of those required to make the diagnosis are present, and symptoms result in no more than minor impairments in
 * social or occupational functioning.
 * Moderate: Symptoms or functional impairment between “mild” and “severe” are present.
 * Severe: Many symptoms in excess of those required to make the diagnosis, or several symptoms that are particularly severe, are present, or the
 * symptoms result in marked impairment in social or occupational functioning.

Table 4.1. Clinically Significant Change Benchmarks with Common Instruments and ADHD Rating Scales * “A” = Away from the clinical range, “B” = Back into the nonclinical range, “C” = Closer to the nonclinical than clinical mean. Sources Consulted:
 * Sullivan, J. R., & Riccio, C. A. (2007). Diagnostic group differences in parent and teacher ratings on the BRIEF and Conners' scales. Journal of Attention Disorders, 11(3), 398-
 * 406.
 * Shemmassian, S. K., & Lee, S. S. (2012). Comparing four methods of integrating parent and teacher symptom ratings of attention-deficit/hyperactivity disorder (ADHD).''Journal
 * of Psychopathology and Behavioral Assessment'', 34(1), 1-10.

Search terms: [ADHD or CONNERS or DBD] AND [clinical significance OR group means] in PsycINFO Section 4.2: Process Measures 1. CBCL Attention Problems Subscale: Could be used on a weekly basis to track changes in ADHD symptomotology. T-scores from this measure could also be recorded on a weekly basis to determine if reliable and clinically significant changes in ADHD symptoms are occuring. The CBCL Attention Problems Subscale has repeatedly demonstrated good-to-excellent convergence with diagnostic interviews for diagnosing ADHD (Pelham et al., 2005; Lampert, Polanczyk, Tramontina, Mardini, & Rohde, 2004; Hudziak et al, 2004; Chen et al., 1994). The CBCL Attention Problems Subscale is a scale on the CBCL, which is readily available at the Finley Clinic.

2. Daily Report Card: Several scholars have pointed out that it is equally important to track changes in the functional behaviors that a child with ADHD engages in, in addition to their ADHD symptoms, to capture the full range of adaptive changes that are made by children with ADHD throughout the course of treatment (Pelham et. al, 2005; Sowerby & Tripp, 2009). The daily report card is a mechanism by which such adaptive behavioral changes can be tracked. When implementing the daily report card, problematic child behaviors at home and at school are targeted for change. Rewards are offered to the child for reaching daily and weekly goals for reducing maladaptive behaviors and increasing adaptive behaviors. Parents and Teachers track child behaviors on a daily basis and provide feedback to one another and the child with behavior frequency counts and/or daily "grades" on how well the child behaved. Daily report cards are a mainstay of cognitive-behavioral and behavioral modification evidence-based intervention strategies for ADHD (DuPaul et al., 2012; Eiraldi et al., 2012) and are highly recommended for tracking child treatment outcomes. Instructions for creating a daily report card are attached in Appendix 1. Sources Consulted that have not yet been cited: Lampert, T. L., Polanczyk, G. G., Tramontina, S. S., Mardini, V. V., & Rohde, L. A. (2004). Diagnostic performance of the CBCL-
 * Attention Problem Scale as a screening measure in a sample of Brazilian children with ADHD. Journal of Attention Disorders, 8(2),
 * 63-71.

Sowerby, P., & Tripp, G. (2009). Evidence-based assessment of attention-deficit hyperactivity disorder (ADHD). In J. L. Matson, F.
 * Andrasik, M. L. Matson (Eds.), Assessing childhood psychopathology and developmental disabilities (pp. 209-239). New York, NY
 * US: Springer Science + Business Media.