Disruptive Behavior Disorders Rating Scale: Fill & Download for Free

Image: copyright © 2018 Martin Silvertant (EmbraceASD.com)This is part 3 of a 4-part series on sleep problems and ASDSleep problems pt. 1 – PrevalenceSleep problems pt. 2 – CausesSleep problems pt. 3 – EffectsSleep problems pt. 4 – SolutionsResearch shows that sleep problems worsen autism symptoms across most core domains[1]—particularly in the social domain[2]—and were the highest predictor of challenging behaviors in ASD.[3]Correlations with dysfunctionsChildren with high-functioning ASD experience more sleep-related anxiety, night waking, parasomnias, sleep disordered breathing, and daytime sleepiness than neurotypicals.[4]Certain sleep problems were found to correlate with certain dysfunctions:[5]Sleep duration and resistance to falling asleep correlated with behavioral regulation and executive dysfunction.The ability to fall asleep quickly correlated with working memory.The ability to remain asleep through the night correlated with accuracy and efficiency of inhibiting conflicting information.Sleep disordersA study from 2015 that investigated the correlation between sleep disorders and the behavior of people with ASD found correlations between sleep disorders and thinking- and behavioral problems:[6]Disorders of arousal (sleepwalking, sleep terrors, and confusional arousals) were correlated with thinking problems.Disorders of excessive somnolence (i.e. desire to sleep) were correlated with thinking and behavioral problems.The high frequency of sleep disorders were found to correlate with some of the behavioral traits that people with ASD already exhibit (see below).[7]Behavioral traitsThe behavioral profiles of individuals with ASD were characterized by behavioral problems such as social anxiety and depression; withdrawal; and somatic, thought, attention, delinquency, aggression, internalizing, externalizing, and total behavioral problems.[8]Comparison between controls and individuals with ASD with clinical (abnormal) or borderline values in the scores for behavioral problems. Percentage (%) of subjects with clinical or borderline scores in each scale of behavior found in the Child Behavior Check List (CBCL) in the control and ASD groups.An overviewStudies exploring the relationship between sleep and challenging behaviors in ASD found:[9]Fewer hours of sleep per night predicted ASD severity score, social skill deficit, and stereotypic behavior.[10]Hypersensitivity to stimuli, younger age, co-sleeping, medication, epilepsy, history of sleep problems, and ADHD was associated with sleep problems in individuals with ASD.[11]PDD children with sleep problems had higher rates of ADHD, oppositional behavior, and psychiatric symptoms compared to children without sleep problems.[12]Controlling for diagnosis and age, night-time sleep problems determined by parent report were significantly associated with decrements in daytime behavior.[13]Sleep problems increased with severity of ASD symptoms. Oppositional behavior, aggression, ADHD, and mood variability predicted sleep disturbance in ASD.[14]Poor sleepers with ASD had more ADHD symptoms and more restricted and repetitive behaviors (RRBs) than good sleepers. Sleep fragmentation was correlated with more RRBs.[15]Sleep problems were the highest predictor of challenging behaviors in ASD.[16]In the ASD group, poor sleep quality and hygiene were related to higher levels of externalizing behaviors.[17]Poor sleepers had a higher percentage of behavioral problems on all PCQ scales (e.g., aggression, RRBs, stereotypy, and hyperactivity) than good sleepers.[18]Moderate-severe sleep problems in ASD resulted in higher daytime externalizing behavior and poorer adaptive skills than those with ASD with no sleep problems.[19]Parent-reported sleep problem but not actigraphy recordings were associated with more core behavior problems in ASD.[20]Sleep-onset delay and duration was positively correlated with ASD severity and symptoms and was the strongest predictor of communication deficits and stereotypic behavior.[21]Communication abnormalities and RRBs were associated with increased risk of sleep problems in ASD. ASD individuals had higher, internalizing, and externalizing problems compared to their unaffected siblings.[22]Children who slept fewer hours per night had lower IQ, verbal skills, adaptive functioning, socialization, and communication skills.[23]Anxiety, ASD severity, sensory sensitivity, and GI issues all predicted sleep disturbance. IQ positively predicted sleep disturbance.[24]Avoidant behavior, under-eating, and GI symptoms predicted sleep problems in individuals with an ASD.[25]The ASD group had more sleep disturbance than the TYP group. Sleep disturbance decreased over the year in children with ASD, and this was associated with improved social ability.[26]This post can also be found on Embrace ASD: Sleep problems pt. 3 – EffectsRead part 4 here: Sleep problems pt. 4 – SolutionsFor more information on high-functioning autism, visit EmbraceASD.comFootnotes[1] The relationship between sleep and behavior in autism spectrum disorder (ASD): a review[2] Sleep problems as possible predictors of intensified symptoms of autism.[3] Sleep, anxiety and challenging behaviour in children with intellectual disability and/or autism spectrum disorder.[4] Sleep and Executive Functioning Among High-IQ School-Aged Children with Autism | Request PDF[5] https://www.researchgate.net/publication/268143591_Sleep_and_Executive_Functioning_Among_High-IQ_School-Aged_Children_with_Autism[6] Influence of sleep disorders on the behavior of individuals with autism spectrum disorder[7] Influence of sleep disorders on the behavior of individuals with autism spectrum disorder[8] Influence of sleep disorders on the behavior of individuals with autism spectrum disorder[9] The relationship between sleep and behavior in autism spectrum disorder (ASD): a review[10] Sleep problems as possible predictors of intensified symptoms of autism.[11] Sleep disturbances and correlates of children with autism spectrum disorders.[12] Sleep disturbance and its relation to DSM-IV psychiatric symptoms in preschool-age children with pervasive developmental disorder and community con... - PubMed - NCBI[13] Sleep problems, sleepiness and daytime behavior in preschool-age children.[14] Variables related to sleep problems in children with autism[15] Defining the sleep phenotype in children with autism.[16] Sleep, anxiety and challenging behaviour in children with intellectual disability and/or autism spectrum disorder.[17] The relation among sleep, routines, and externalizing behavior in children with an autism spectrum disorder[18] Sleep is associated with problem behaviors in children and adolescents with Autism Spectrum Disorders[19] The relationship between sleep problems and daytime behavior in children of different ages with autism spectrum disorders.[20] Sleep and daytime functioning: a short-term longitudinal study of three preschool-age comparison groups.[21] Sleep Problems and Symptom Severity[22] Sleep problems and their correlates and comorbid psychopathology of children with autism spectrum disorders[23] Sleep disruption as a correlate to cognitive and adaptive behavior problems in autism spectrum disorders.[24] Correlates and risk markers for sleep disturbance in participants of the Autism Treatment Network.[25] An investigation of comorbid psychological disorders, sleep problems, gastrointestinal symptoms and epilepsy in children and adolescents with Autism Spectrum Disorder[26] Sleep in high-functioning children with autism: longitudinal developmental change and associations with behavior problems.

Right there in your question is the problem.There is no standard test to diagnose ADHD, so the vast majority of people that are credentialed to make that diagnosis don’t actually understand it well enough to do a valid differential diagnosis when there is any ambiguity.(Differential diagnosis is the basis of almost every medical drama, some bizarre symptoms that don’t add up to anything common and House or whomever has to tease things out and find the symptom combination that suddenly identifies the true problem.)There are normalized symptom checklists that the person, teachers/boss and parent/spouse can complete. Those checklists are indeed valid, but not complete, because ADHD is to complex to boil the potential ways it can be expressed down into a black and white checklist. Thus, they have just enough imprecision to also be error prone when doing a very detailed differential diagnosis.I have done a ridiculous amount of literature review study on the diagnosis/treatment of ADHD and the root causes behind it. I also happen to have ADHD, which is part of what fueled my interest in it.I will split this answer into 3 parts: ADHD is???; Over-diagnosis; Miss-diagnosisWhat is ADHD? You have to understand the original to truly understand how it gets missed or mixed up.ADHD is a disorder of the sensory and impulse processing center in the brain.That is all? Yes, but it is more than enough once that function is understood.Impulses and thoughts are not adequately filtered which results in movement (or an inexplicably high level of restlessness in Adults). That movement and excessive interaction is likely to seem random, but often has common themes surrounding the person’s interests and environment.Sensory and impulse processing also manages assignment of priorities to those concepts, this results in a couple different issues.This means that all notable sensory input has an equal chance at becoming the primary thought of the moment but does not guarantee that it will keep that spot.So attention and behavior can change rapidly as new information is processed.UNLESS: When the person with ADHD is doing something they enjoy or has some form of immediate reward, especially if it requires some basic level of concentration to succeed, they can become so engrossed in that activity that they are almost totally impossible to interrupt. New sensory input, like your mom calling you to dinner or your boss asking you to come show them your project, can be totally missed, because the immediate reward of enjoying your activity overwhelms any valuation that new input could have had.That sense of being stuck can also make transitioning difficult when the person is unable to dismiss that issue or task by reducing it’s neurological priority and promoting the priority on the new activity.Prioritization also explains procrastination until just before a due date followed by frantic, but potentially successful, efforts to complete the task.Social cues: people instinctively learn to read social cues as they grow and develop socially, however, people with ADHD often simply miss them and present as very socially awkward when in larger groups where there is more input to attempt to read.There are more ramifications, but I think I have covered the pieces I usually get asked about, and this is getting longer than I prefer. Please add comments if there is any symptom you are curious about or confused by and I will help connect to the root cause,Over-diagnosis which presumes the disorder is not present but is diagnosed incorrectly;First off, kids are very active and mobile by nature, so determining a line between normal activity and ADHD activity levels generally comes down to examining the consequences and repetition of the behavior.Some parents and many schools are quick to push for medicating children that become disruptive because they don’t have the time or resources to contain them.In those circumstances, it is easy to present the consequences of the behavior in a pessimistic manner and artificially increase the rating scale values for those behaviors.Difficulty sleeping, limited impulse control and severe mood dis-regulation are all potential symptoms of either Bipolar disorder or ADHD. When viewed out of context, it is easy to look at ADHD rater scales that indicate academic impacts and make the diagnosis “appropriate to that setting”. The fallacy of course being that disorders are not setting dependent, even if some of their symptoms seem to be at times.And Miss-diagnosis which presumes the disorder is present but is completely missed or is miss-identified.When multiple areas of your life are a constant struggle, depressed mood is an expected result. Couple that with the apparent loss of motivation in long term goals and there is very often a valid diagnosis of “secondary depression”, however, couple that with impulse control problems and difficulty sleeping due to difficulty getting your thoughts to be quiet and a physician can make the opposite leap vs the last paragraph in the previous section of my answer and diagnose Bipolar disorder.In several cases, I have seen people diagnosed with depression and anxiety (lacking motivation=depression and a sense of feeling overwhelmed by stimuli you are unable to process or ignore properly looks a lot like anxiety or agitation. Antidepressants can often improve those cases at varying levels of subtly and anti anxiety medication can slow the mind down to help with sleep and feeling calmer, these pseudo improvements are often enough to “confirm” the diagnosis for the physician doing the prescribing despite the ongoing issues with focus and prioritization etc.When completely missed, it is often because the person has developed various tools strategies to keep themselves functioning at some adequate level. Downside being that those strategies are masking the symptoms and artificially lowering the rating scales.The DSM 5 has addressed that by explicitly stating that symptom checklists for adolescents and adults should be completed as if the person were not medicated and using not unusual methods to manage time.I am out of time for typing at the moment, but will come back to expand this answer if there is enough attention/response to make it worth doing.

This is from ADDitude Slide Show it was written by June SilnyThis is the perfect explanation of how I feel with ADHD.The civil war inside my brainADHD is a perplexing, frustrating, and disruptive condition still too often questioned and misunderstood. We are smart, people say. We just need to try harder, or get organized, or stop procrastinating. If only it were that easy. Here's the truth about why we can't always do what is good for us.1. ADHD is Real.If you have ADHD, you know it’s real. Too real. Inescapable and undeniable, in fact. But to anyone standing outside our brains, ADHD is a confusing, contradictory concept.My loved ones scratch their heads, trying to reconcile my intelligence with my sometimes careless, spaced-out, and clueless behavior. “How can such a smart, capable person makes such foolish choices,” they ask. They become convinced that I just don’t care or I’m not applying myself. “If you wanted to, you could do it,” they say. When I insist that I can’t, the response is something like, “Don’t say you ‘can’t.’ That’s nonsense. You’re just making excuses for something you don’t want to do.”2. ADHD Is a ParadoxMost ADHD traits reflect two extremes on a single continuum. For example, it’s impossible for me to focus on something boring or tedious; but I can zone in and lose half a day doing something I love. When I fall into this hyperfocus, I don’t hear phones ringing, I don’t feel hunger pangs, and I don’t make trips to the restroom. My sparked brain is excited and addicted to the joy of being in the moment. In a split second, I can jump from restless distraction to extreme hyperfocus. ADHD is a condition of contradictions.3. ADHD is a Brain PhenomenonMy ADHD brain patterns are difficult for even me to fathom at times. And by “at times,” I mean practically constantly.I am bombarded daily by self-doubt and self-criticism, despite the fact that I know my behavior is not willful; it is steered by chemicals in my brain called neurotransmitters. In ADHD brains, these neurotransmitters are sluggish in the areas that control attention, which seems odd because our active minds are constantly in gear. This chemical imbalance confounds researchers, who suspect it’s largely genetic. But since there is no way to prove ADHD beyond a behavior checklist and a handful of rating scales, it is even harder to believe.If you love someone with ADHD, you will recognize the differences in their brain chemistry. Managing simple tasks is rarely easy for us, and those who love us know we’re not faking our struggle.4. Every Day is a StruggleMost people cannot fathom the number and complexity of daily challenges we fight our way through. The simplest tasks become overwhelming burdens. A bill payment, phone call, or errand can suck out all of our energy.I am a capable person who functions well in many areas of life, so why in the world can’t I pay a bill on time? The answer is rarely hiding in the task itself, but rather in a specific component that triggers a warning light in my ADHD brain telling me to beware of something uncomfortable. That painful encounter might be a decision that I cannot make, a deadline that I cannot foresee, detailed instructions that I won’t understand, or something so boring that I just can’t bear it.5. Self-Doubt is an ADHD By-ProductMost people could not tolerate the voices that echo in my head all day, pointing out every little thing I've done wrong: Why did I say that? How could I forget to pay the bills? Why didn’t I wake up on time? What is the matter with me? I’m dumb. How could I be so forgetful? Why can’t I say no? How could I forget to buy eggs when I’m holding the shopping list in my hand?This relentless barrage of self-reproach make us feel unworthy, incapable, and inadequate. We are our own harshest critics.6. We are Trying Harder Than You Can ImagineADHD is largely invisible. We try very hard, but no one can see our internal struggle or effort. We’re going through a lot but we’ve become good at hiding it. All we’re asking for is a little compassion, patience, and non-judgmental love. That means no rolling eyes, no dirty looks, and no scolding us when we’re a few minutes late or can’t find our keys. If you can do that, we will try harder. We will figure out how to get through our rough spots if you promise to stand by our side, support us, cheer us on, and wait for us at the finish line. That’s when we do our best.7. Tough Love Doesn't WorkThis truth may be the hardest for neurotypical spouses, parents, and bosses to accept. ADHD is biologically woven into our DNA. It never goes away (though it can be managed). Telling us to suck it up and try harder is like telling a visually impaired person to see harder. You can’t see what he sees; you trust him when he tells you the world is a blur, and you let his glasses do their job. It’s the same with ADHD. Trust us that we would fix our symptoms if we could, and we’re doing our best with the tools we have.8. We Don't Process Thoughts Like You DoADHD thoughts are like Gorilla Glue — quick to stick and impossible to oust. They don’t harmoniously flow in and out. They rhythmically cycle through our minds like a scratched, broken record. Or they shoot like stones from a cannon, bombarding us until we crash or surrender from overwhelm. Our thoughts are loud. They steal our attention away from jobs and conversations, which makes us seem disinterested or rude. Our attention might briefly drift away, but please be patient. Give us a gentle tap on the shoulder or time to separate our thoughts from your voice, and we will be present again.9. We Feel Everything Stronger, Louder, MoreWhether anger, worry, or betrayal, our emotions are never mild. We feel intensely. Add to that our ADHD impulsivity, and you might understand the explosions of emotion that shows up in a flash. Some experts call this “flooding.” With passionate urgency, words come flying out of our mouths before we can process what it is we want to say. We say words we soon regret, frequently apologizing and requesting forgiveness.10. Time Feels Like a Foreign LanguagePeople with ADHD live in the here and now. Future dates and times don’t compute (another reason tough love and consequences don’t work). All that matters is this moment — right here, right now. When thinking of a future date (unless it is something we are hyper-stimulated about like a wedding), time is not a language we speak. As Dr. Ned Hallowell explains, “We have two times: now and not now.” The future disappears.11. ADHD is Not an Excuse“I forgot.” “I’m trying my hardest.” “I’m sorry.” These may sound like excuses or escape routes; they are not. “I messed up because of my ADHD” is not a popular explanation. But, it’s true. ADHD is why we do what we do. This is hard to explain — in part because it doesn’t even make sense to us. ADHD isn’t real, unless you are the one who has it. It’s frustrating to have a disorder no one believes. One thing is irrefutable: ADHD is illogical.12. ADHD is Not HopelessADHD is a perplexing, frustrating, and disruptive condition still too often questioned and misunderstood. We are smart, people say. We just need to try harder, or get organized, or stop procrastinating. If only it were that easy. Here's the truth about why we can't always do what is good for us.By June SlineyTo quote Steve Jobs, “Here's to the crazy ones, the misfits, the rebels, the troublemakers, the round pegs in the square holes... the ones who see things differently; they're not fond of rules, and they have no respect for the status quo. You can quote them, disagree with them, glorify or vilify them, but the only thing you can't do is ignore them because they change things. They push the human race forward, and while some may see them as the crazy ones, we see genius, because the people who are crazy enough to think that they can change the world, are the ones who do."