Assessment of ADHD

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Dont Get Overwhelmed

• Assessment of ADHD
• Four 15 minute office visits
• Treatment is NOT an emergency
• Take your time
• Ensure diagnosis is correct

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SNAP-IV Teacher and Parent 18-item Rating Scale
Assessment Tool

• A norm-referenced checklist
• Designed to determine presence of ADHD symptoms
• Can be completed by a parent/caregiver or
  educator
• DSM-IV criteria for ADHD
• Must be at least 6 responses of Quite a Bit or
  Very Much (scored 2 of 3) to either of the
• 9 inattentive items, OR
• 9 hyperactive-impulsive items, OR
• Both on the 18-item rating scale

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Assessment Tool
SNAP-IV Teacher and Parent 18-item Rating Scale

• Young person must meet the following criteria
• Some symptoms present before age 7 years
• Some impairment present in two or more settings
• Social, academic or occupational
• Clear evidence of clinically significant
  impairment
• In social or academic functioning
• Must not be primarily due to any other factors or
  conditions
• Mood Disorder, Anxiety Disorder,
• Dissociative Disorders, Personality Disorder

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SNAP-IV Teacher and Parent 18-item Rating Scale
Assessment Tool

• Rating scale alone not sufficient to diagnose
• For diagnosis and clinical intervention must
  have
• Complete history
• Appropriate physical examination
• Ensure DSM-IV-TR criteria is met

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SNAP-IV Teacher and Parent 18-item Rating Scale
Assessment Tool

• If a SNAP-IV score of 18 or higher
• Discuss important issues/problems in
  childs/youths life/environment
• Child Use the Child Functional Assessment (CFA)
  to determine impact on functioning
• Youth Screen for Depression
• Use the Kutcher Adolescent Depression Screen
  (KADS)
• Complete or use the Teen Functional Activities
  Assessment (TeFA) to determine the impact on
  functioning

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Monitoring and Intervention Tools ADHD

• Monitoring
• CGI
• TeFA
• TASR-A
• CFA
• SNAP-IV
• Interventions (these do not replace medications
  or psychotherapies)
• PST
• WRP

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If risk factors are substantial or if three or
more positives answers on either the Parent or
Child Version of the Screening Tool or CFA
suggests dysfunction due to ADHD like symptoms -
Use the Psychotherapeutic Support for Children
(PSC) and Stress Reduction Prescription (WRP)
(proceed to step 2 in 1 - 2 weeks.) Complete
SNAP-IV. Provide SNAP-IV to parents and teachers.
Provide information about ADHD and its
treatment. Obtain informed consent to allow
discussion with the school.
Children
Visit 1
Consider risk factors Apply screening
tool Complete CFA Complete SNAP-IV
If fewer than 3 positive answers on The Parent or
Adolescent version of the Screening Tool -
consider other possible explanations for
signs/symptoms such as environmental stressors,
Oppositional Defiant Disorder, Conduct Disorder,
Learning Disorder. Use the Psychotherapeutic
Support for Children (PSC) and Worry Reduction
Prescription (WRP) and monitor again in a month
and repeat STEP I and review other possible
psychiatric conditions.
If SNAP-IV 18 gt 18 (or a mean score of greater
than 1) and CFA shows decrease in function -
continue with PST and WRP strategies - proceed to
step 3 within a week. Review SNAP-IV from
parents and teachers for scores as above.
Discuss ADHD and its treatment and encourage
google search.
Visit 2
 SNAP-IV 18 item CFA Use PST and WRP
If SNAP-IV 18 lt18 (or a mean score of greater
than 1) and shows no decrease in function
continue with PST and WRP strategies and monitor
again in a month advise to call if feeling worse
or problems escalate.
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Children
If SNAP-IV 18 remains gt 18 (or a mean score of
greater than 1) and CFA shows functioning
problems proceed to diagnosis (review
DSM-IV-TR criteria) and treatment after
discussion of ADHD and treatment options
Visit 3
SNAP-IV 18 CFA Use PST and WRP
If SNAP-IV 18 lt18 (or a mean score of greater
than 1) and CFA shows no decrease in function
continue with PST and WRP strategies - monitor
again with SNAP-IV 18 and CFA in one month
advise to call if feeling worse or problems
escalate. Consider Strongest Families BC.
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If risk factors are substantial or if two or more
positives answers on either the Parent or
Adolescent Version of the Screening Tool or TeFA
suggests dysfunction due to ADHD like symptoms -
Use Psychotherapeutic Support for Teens (PST) and
Stress Reduction Prescription (WRP) , see page 21
- proceed to step 2 in 1 - 2 weeks Provide
SNAP-IV to parents and teachers (school contact
can be through parents if feasible). Complete
SNAP-IV 18. Provide information about ADHD and
its treatment. Obtain informed consent to allow
discussion with the school.
Youth
Visit 1
Consider risk factors Apply screening tool
TeFA SNAP-IV
If fewer than 3 positive answers on The Parent or
Adolescent version of the Screening tool -
consider other possible explanations for
signs/symptoms such as environmental stressors,
Oppositional Defiant Disorder, Conduct Disorder,
Learning Disorder. Use PST (see page 29) and WRP
(see page 21) and monitor again in a month and
repeat STEP I and review other possible
psychiatric conditions.
If SNAP-IV 18 gt 18 (or a mean score of greater
than 1) and TeFA shows decrease in function -
continue with PST and WRP strategies - proceed to
step 3 within a week. Review SNAP-IV 18 from
parents and teachers for scores as above.
Discuss ADHD and its treatment and encourage
google search.  
Visit 2
 SNAP-IV 18 item TeFA Use PST and WRP
If SNAP-IV 18 lt18 (or a mean score of greater
than 1) and shows no decrease in function
continue with PST and WRP strategies and monitor
again in a month advise to call if feeling worse
or problems escalate.
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Youth
If SNAP-IV 18 remains gt 18 (or a mean score of
greater than 1) and TeFA shows decrease in
function proceed to diagnosis (review DSM-IV-TR
criteria) and treatment.
Visit 3
SNAP-IV 18 TeFA Use PST and WRP
If SNAP-IV 18 lt18 (or a mean score of greater
than 1) and TeFA shows no decrease in function
continue with PST and WRP strategies - monitor
again with SNAP-IV 18 and TeFA in one month
advise to call if suicide thoughts or acts of
self-harm occur or if problems escalate.
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(Clicker Question)
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Co-morbidity in ADHD

• Approx. 30 50 of people with ADHD have other
  psychiatric disorders
• Oppositional Defiant Disorder (ODD)
• Conduct Disorder (CD)
• Learning Disorder
• Discuss academic and behavioral performance
• With teachers and guidance counselor
• Address possibility of a learning disability
• Specialized learning assessments through school
• Develop treatment plan for each disorder
• Address ADHD first as other disorder often
  improves as ADHD improves

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Co-morbidity in ADHD

• Begin treatment
• Refer child/youth to specialty services or
  Stronger Families
• For more intensive behavioral or family
  interventions
• Many with ADHD co-morbid with ODD, CD or LD
  require specialty services
• Primary care provider should be part of the
  treatment plan
• If learning disability is suspected
• Refer for educational psychological testing
• Contact school
• Remedial learning strategies
• Informed written consent to contact school

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• Canadian Attention Deficit Hyperactivity Disorder
  Resource Alliance (CADDRA)

• Dr. Wilma Arruda

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CADDRA

• A national, independent, not-for-profit
  association.
• The voice of doctors who support patients with
  Attention Deficit Hyperactivity Disorder (ADHD)
  and their families.

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CADDRA Vision

• To improve the quality of life and reduce the
  suffering of patients with ADHD and their
  families while maximizing their potential across
  the lifespan.

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CADDRA Mandate

• CADDRA is a national Canadian alliance of
  professionals working in the area of ADHD who are
  dedicated to world class research, education,
  training and advocacy in the area of ADHD.

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CADDRA

• Information for physicians, parents, educators,
  children, adolescents, and adults

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CADDRA Canadian ADHD Practice Guidelines Third
Edition (2011) Download

• Diagnosis and Overview of Visits
• Differential Diagnosis and Comorbid Disorders
• Specific Issues in the Management of Children
  with ADHD Intervention with Parents of Children
  Diagnosed with ADHD
• Specific Issues in the Management of Adolescent
  ADHD
• Specific Issues in the Management of ADHD in
  Adults
• Psychosocial Interventions and Treatments
• Pharmacological Treatment of ADHD
• CADDRA ADHD Assessment Toolkit (CAAT)

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CADRRA Tools www.caddra.ca

• Assessment and Follow-up Forms
• CADDRA ADHD Assessment Form
• Weiss Symptom Record (WSR)
• ADHD Checklist
• SNAP-IV-26
• Adult ADHD Self-Report Scale (ASRS)
• Weiss Functional Impairment Rating Scale Parent
  Report (WFIRS-P)
• Weiss Functional Impairment Rating Scale Self
  Report (WFIRS-S)
• CADDRA Teacher Assessment Form
• CADDRA Clinician ADHD Baseline/Follow-Up Form
• CADDRA Patient ADHD Medication Form

• Handouts
• CADDRA ADHD Information and Resources
• CADDRA Child Assessment Instructions
• CADDRA Adolescent Assessment Instructions
• CADDRA Adult Assessment Instructions
• CADDRA Teachers Instructions

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WSR
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Teacher Assessment
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WSIRS-P
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WFIRS-S
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ADHD Checklist
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ADHD AssessmentForm
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Teacher Instructions
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CADDRA Medication Tables
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Patient ADHD
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• Application of Tools in a GP Office ADHD

• Dr. Matt Blackwood

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Strongest Families

• Evidence-based, educational and coaching
  intervention for disruptive behaviour and/or
  attention deficits in children aged 3 to 12
• Offered by the Canadian Mental Health
  Association BC Division at no cost to patients
• New program, delivered via telephone, which
  works with parents/caregivers in their own home
•  Proven successful in reducing impulsivity,
  improving attention and conduct as well
  benefiting overall child and family functioning
• Operational hours include evening and weekend
• Requires a physician referral (Referral form is
  in your binder)

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Table Discussion

• Which of these tools or techniques discussed do
  you currently use?
• How do you see this fitting into your context?
• How can non-clinician team members contribute to
  administration and completion of the tools?
•  
•  

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• Lunch