10. Often has difficulty maintaining alertness, orienting to requests, or executing directions
11. Often fidgets with hands or feet or squirms in seat
12. Often leaves seat in classroom or in other situations in which remaining seated is expected
13. Often runs about or climbs excessively in situations in which it is inappropriate
14. Often has difficulty playing or engaging in leisure activities quietly
15. Often is "on the go" or often acts as if "driven by a motor"
16. Often talks excessively
17. Often blurts out answers before questions have been completed
18. Often has difficulty awaiting turn
19. Often interrupts or intrudes on others (e.g., butts into conversations/games)
20. Often has difficulty sitting still, being quiet,... inhibiting impulses in...classroom or at home
21. Often loses temper
22. Often argues with adults
23. Often actively defies or refuses adult requests or rules
24. Often deliberately does things that annoy other people
25. Often blames others for his or her mistakes or misbehavior
26. Often touchy or easily annoyed by others
27 Often is angry and resentful
28. Often is spiteful or vindictive
29. Often is quarrelsome
30. Often is negative, defiant, disobedient, or hostile toward authority figures
31. Often makes noises (e.g., humming or odd sounds)
32. Often is excitable, impulsive
33. Often cries easily
34. Often is uncooperative
35. Often acts "smart"
36. Often is restless or overactive
37. Often disturbs other children
38. Often changes mood quickly and drastically
39. Often easily frustrated if demand are not met immediately
40. Often teases other children and interferes with their activities
Check the column which best describes this child: Not at Just a Quite Very
41. Often is aggressive to other children (e.g., picks fights or bullies)
42. Often is destructive with property of others (e.g., vandalism)
43. Often is deceitful (e.g., steals, lies, forges, copies the work of others, or "cons" others)
44. Often and seriously violates rules (e.g....truant, runs away, or completely ignores class rules)
45. Has persistent pattern of violating the basic rights of others or major societal norms
46. Has episodes of failure to resist aggressive impulses (to assault others or to destroy property)
47. Has motor or verbal tics (sudden, rapid, recurrent, nonrhythmic motor or verbal activity)
48. Has repetitive motor behavior (e.g., hand waving, body rocking, or picking at skin)
49. Has obsessions (persistent and intrusive inappropriate ideas, thoughts, or impulses)
50. Has compulsions (repetitive behaviors or mental acts to reduce anxiety or distress)
51. Often is restless or seems keyed up or on edge
52. Often is easily fatigued
53. Often has difficulty concentrating (mind goes blank)
54. Often is irritable
55. Often has muscle tension
56. Often has excessive anxiety and worry (e.g., apprehensive expectation)
57. Often has daytime sleepiness (unintended sleeping in inappropriate situations)
58. Often has excessive emotionality and attention-seeking behavior
59. Often has need for undue admiration, grandiose behavior, or lack of empathy
60. Often has instability in relationships with others, reactive mood, and impulsivity
61 Sometimes for at least a week has inflated self-esteem or grandiosity
62. Sometimes for at least a week is more talkative than usual or seems pressured to keep talking
63. Sometimes for at least a week has flight of ideas or says that thoughts are racing
64. Sometimes for at least a week has elevated, expansive or euphoric mood
65. Sometimes for at least a week is excessively involved in pleasurable but risky activities
66. Sometimes for at least 2 weeks has depressed mood (sad, hopeless, discouraged)
67. Sometimes for at least 2 weeks has irritable or cranky mood (not just when frustrated)
68. Sometimes for at least 2 weeks has markedly diminished interest or pleasure in most activities
69. Sometimes for at least 2 weeks has psychomotor agitation (even more active than usual)
70. Sometimes for at least 2 weeks has psychomotor retardation (slowed down in most activities)
71. Sometimes for at least 2 weeks is fatigued or has loss of energy
72. Sometimes for at least 2 weeks has feelings of worthlessness or excessive, inappropriate guilt
73. Sometimes for at least 2 weeks has diminished ability to think or concentrate
74. Chronic low self-esteem most of the time for at least a year
75. Chronic poor concentration or difficulty making decisions most of the time for at least a year
76. Chronic feelings of hopelessness most of the time for at least a year
77. Currently is hypervigilant (overly watchful or alert) or has exaggerated startle response
78. Currently is irritable, has anger outbursts, or has difficulty concentrating
79. Currently has an emotional (e.g., nervous, worried, hopeless, tearful) response to stress
80. Currently has a behavioral (e.g., fighting, vandalism, truancy) response to stress
81. Has difficulty getting started on classroom assignments
82. Has difficulty staying on task for an entire classroom period
83. Has problems in completion of work on classroom assignments
84. Has problems in accuracy or neatness of written work in the classroom
85. Has difficulty attending to a group classroom activity or discussion
86. Has difficulty making transitions to the next topic or classroom period
87. Has problems in interactions with peers in the classroom
88. Has problems in interactions with staff (teacher or aide)
89. Has difficulty remaining quiet according to classroom rules ____ ____ ____ ____ 90. Has difficulty staying seated according to classroom rules
Swanson, N.d.; see Appendix B for "Scoring Instructions for the SNAP-IV-C Rating Scale")
Antipsychotic Medicines the following excerpts from 2006 University Wire release relate critical concerns regarding treatment of ADHD with drugs.
The Daily Universe) (U-WIRE) PROVO, Utah -- Risks of serious injury and even death associated with stimulants to treat attention-deficit (hyperactivity) disorder merit stricter warning labels for those drugs, a federal panel said
The panel advised the Food and Drug Administration to add a "black box" warning to methylphenidates like Ritalin to emphasize potential cardiovascular problems the drugs could cause. Although the FDA doesn't need to heed the panel's advice, it often does.
The panel's announcement came after an FDA database search found 25 deaths -- including 19 children -- linked to the stimulants in the past five years.
Utah has the 10th lowest rate of ADHD diagnosis in the nation, but local pharmacists and psychiatrists still see plenty of cases in both children and adults.
According to the Utah Health Data Committee Web site, psychiatrists in Utah prescribed more than 1.7 million doses of methylphenidates in 2003. Ritalin, Concerta, Methylin and Metadate -- all candidates for the label change -- were prescribed most frequently.
Marianne Hawkins, a nurse at Utah Valley Regional Medical Center's outpatient psychology office, said the psychiatrists she works with try to avoid prescribing medication if at all possible.
ADHD occurs in people of all ages, but until 2001, only children were diagnosed. Hawkins said adults are rarely diagnosed and treated for ADHD in her office. She estimated about 97% of ADHD patients she worked with were children.
When a child is diagnosed with ADHD, psychiatrists meet with the child's parents to map out a behavior modification plan. This includes setting goals and counseling with the parents and child to reach those goals. Teachers are often involved, too.
If behavior therapy doesn't work, a psychiatrist will prescribe methylphenidates. Usually mixing behavior therapy with a low dose of the drugs is the best cure. Dosage tapers off as the child grows up until the drugs are no longer needed.
Ritalin, the most well-known methylphenidate, has been on the market since 1955. Laurie Ostroff-Landau, spokesperson for Ritalin's producer, Novaris, said extensive clinical trials were run before Ritalin hit the market 50 years ago. Research on its safety has continued since.
There are always going to be risks involved with medication," [Jim Averett, a pharmacist at the BYU Student Health Center,] said."You as the patient need to decide if the benefits outweigh the risks." (Cloward, 2006)
William Cooper, M.D., M.P.H., associate professor of Pediatrics in the Child and Adolescent Health Research Unit, a lead researcher at the Monroe Carell Jr. Children's Hospital at Vanderbilt, documents a disturbing trend that doctors currently prescribe "antipsychotic medicines for children with behavioral problems that are not defined as 'psychosis,' such as attention deficit hyperactivity disorder (ADHD)." ("Vanderbilt Children's Hospital Research" 2006) Cooper states the antipsychotic medications are particularly prescribed for boys with behavioral problems and ADHD.
The study, "Trends in Prescribing of Antipsychotic Medications for U.S. Children" was released today in the March-April issue of the journal Ambulatory Pediatrics. It documented that the overall frequency of antipsychotic prescribing in the U.S. increased fivefold -- from out of 1,000 U.S. children in 1995-1996 to 39.4 out of 1,000 children in 2001-2002. ("Vanderbilt Children's Hospital Research" 2006)
The following figure (4) depicts the increase in the number of children per 1000 prescribed antipsychotic drugs.
Figure 4: Increase of Prescribed Antipsychotic Drugs for Children ("Vanderbilt Children's Hospital Research" 2006)
Medication With Therapy Approximately two-thirds of parents (66) and…