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The ADHD Story

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ADHD a Neurobiological Condition is related to SLD ... 50-65% of children still manifest symptoms into Adulthood (Korn & Weiss, 2003) ... – PowerPoint PPT presentation

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Title: The ADHD Story


1
The ADHD Story
  • James J. Messina, Ph.D.
  • Go to www.coping.org
  • for ADHD Articles Links

2
ADHD a Neurobiological Condition is related to SLD
  • Attention Deficit Hyperactivity Disorder (ADHD) -
    with Inattention and/or Impulsivity
  • Specific Learning Disability (SLD) - with
    Auditory, Visual or Kinesthetic Processing
    Problems including Dyslexia/Reading Disorder

3
Other Neurobiological Conditions Related to ADHD
  • Central Auditory Processing Disorder (CAPD)
  • Sensory Integration Disorder
  • Motor Planning Disorder
  • Self-Regulatory Disorder
  • Autistic Spectrum Disorder - PDD, MSD, Globally
    Delayed, Autistic
  • Neurological Conditions Epilepsy, Tourette
    Syndrome

4
What Research is Telling Us about ADHD
  • Genetically transmitted in 70-95 of cases
  • Results from chemical imbalance or deficiency in
    certain neurotransmitters-chemicals which help
    brain regulate behavior
  • Rate at which brain uses glucose, its main energy
    source, is lower in subjects with ADHD than those
    without (Zametkin et al, 1990)
  • Depressed release of Dopamine might have role in
    ADHD (Volkow et al, 2003)

5
Research also tells us about ADHD that
  • Central pathological deficits of ADHD are linked
    to several specific brain regions
  • Frontal Lobe
  • Its connections to Basal Ganglia
  • Their relationships to central aspect of
    Cerebellum
  • Less electrical activity in brain show less
    reactivity to stimulation in one or more of above
    brain regions
  • Brains are 3-4 smaller-in more severe-frontal
    lobes, temporal gray matter, caudate nucleus
    cerebellum were smaller

6
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8
PET Scan of Metabolism of Glucose Adult Brain
with ADHD
  • Positron Emission Tomography (PET) Pictures of
  • Adult with ADHD Normal Adult

9
ADHD LD lead to Diminished Executive Functions
  • Deficient self-regulation of behavior, mood,
    response
  • Impaired ability to organize/plan behavior over
    time
  • Inability to direct behavior toward future
  • Diminished social effectiveness adaptability

10
What is the Impact of these Disorders?
  • Neurologically based behavioral issues can keep
    child from developing normally
  • Lack of full coordination of gross fine motor
    skills
  • Lack of complete age appropriate speech, language
    communications
  • Impaired self-esteem

11
What is the Extent of ADHD?
  • About 3 of school-aged population have full ADHD
    symptoms another 5-10 have partial ADHD
  • Another 15-20 of school-aged population show
    transient behaviors suggestive of ADHD
  • Boys are 3 times more likely than girls to have
    ADHD
  • Symptoms decrease with age but 50-65 of children
    still manifest symptoms into Adulthood (Korn
    Weiss, 2003)

12
What is the Extent of SLD?
  • 15 of Americans have learning disabilities with
    many going untreated due to lack of diagnosis
  • 10 million children or approximately 1 in 5
    children in 1st through 9th grades (Cramer
    Ellis, 1996)
  • 60 of adults with severe literacy problems have
    undetected/untreated LD (NALLDC, 1994)

13
What is the Impact of ADHD on people? (Barkley,
2002)
  • 32-40 of students with ADHD drop out of school
  • Only 5-10 will complete college
  • 50-70 have few or no friends
  • 70-80 will under-perform at work
  • 40-50 will engage in antisocial activities
  • More likely to experience teen pregnancy
    sexually transmitted diseases
  • Have more accidents speed excessively
  • Experience depression personality disorders

14
What is the Impact of these Disorders?
  • 35 of students with learning disabilities drop
    out of school
  • 30 of adolescents with learning disabilities
    will be arrested 3 to 5 years out of High School
    (Wagner et al, 1993)
  • Previously undetected learning disabilities have
    been found in 50 of juvenile delinquents - Once
    treated their recidivism drops to just 2
    (Lerner, 1997)

15
Attention Deficit Hyperactivity Disorder
  • Inattention - Traditionally known as ADD

  • Impulsivity - Traditionally known as
    Hyperactivity

16
ADHD Characteristics
  • Inattention
  • Impulsivity
  • Overactivity

17
Inattention-Distractibility
  • Doesnt seem to listen
  • Fails to finish assigned tasks
  • Often loses things
  • Cant concentrate
  • Easily distracted
  • Daydreams
  • Requires frequent redirection
  • Can be very quiet missed

18
Impulsivity-Behavioral Disinhibition
  • Rushing into things
  • Careless errors
  • Risk taking
  • Taking dares
  • Accidents/injuries prone
  • Impatience
  • Interruptions

19
Hyperactivity - Overarousal
  • Restlessness
  • Cant sit still
  • Talks excessively
  • Fidgeting
  • Always on the go
  • Easy arousal
  • Lots of body movement

20
Different Names for ADHD Through the years
  • 1902 Defects in moral character
  • 1934 Organically driven
  • 1940 Minimal Brain Syndrome
  • 1957 Hyperkinetic Impulse Disorder
  • 1960 Minimal Brain Dysfunction (MBD)
  • 1968 Hyperkinetic Reaction of Childhood (DSM II)
  • 1980 Attention Deficit Disorder - ADD (DSM III)
    with-hyperactivity without-hyperactivity residual
    type

21
Names for ADHD
  • 1987 Attention-Deficit Hyperactivity Disorder or
    Undifferentiated Attention Deficit Disorder
    (DSM III-R)
  • 1994 Attention-Deficit/Hyperactivity Disorder
    (DSM IV)

    314.01 ADHD, Combined Type

    314.00 ADHD, Predominantly Inattentive type
    314.01 ADHD, Predominantly
    Hyperactive-Impulsive Type

22
What is Learning Disability?
  • Definition
  • A learning disability is a disorder that affects
    a persons ability to either interpret what is
    seen and heard or to link information from
    different parts of the brain. These limitations
    can show up in many ways - as specific
    difficulties with spoken and written language,
    coordination, self-control, or attention. Such
    difficulties extend to school work and can impede
    learning to read or write or do math.

23
What are Learning Disabilities
  • Neurological in origin
  • Impede persons ability to store, process or
    produce information
  • Affect ability to read
  • Affect ability to speak
  • Affect ability to compute math
  • Impair socialization

24
LD Language Symptoms
  • Pronunciation problems
  • Slow vocabulary growth
  • Lack of interest in stories
  • Poor spelling
  • Delayed decoding
  • Poor reading comprehension
  • Trouble following directions
  • Lack of verbal participation in class

25
LD Memory Symptoms
  • Trouble learning numbers, alphabet days of the
    week
  • Slow acquisition of new skills
  • Poor memory for routines
  • Slow recall of facts
  • Organizational problems

26
LD Attention Symptoms
  • Trouble sitting still
  • Extreme restlessness
  • Impersistence at tasks
  • Impulsivity
  • Inconsistency
  • Poor self-monitoring, insatiability
  • Great knowledge of trivia
  • Careless errors

27
LD Fine Motor Skill Symptoms
  • Trouble learning self-help skills
  • Clumsiness
  • Reluctance to draw, trace or color
  • Poor pencil grasp
  • Poor letter formation
  • Fist-like or tight pencil grasp

28
Rule outs for Diagnosis of ADHD
29
GARLIC V.S. ONION-Rule out System in Diagnosing
ADHD
  • Rule of Thumb of Ruling out Garlic Issues
  • Garlics odor outdoes Onions so treat Garlic
    first
  • Rule out Garlic issue or treat it prior to
    addressing Onion issue
  • Lack of success in treating Onion may be because
    Garlic was not identified treated
  • Ongoing setbacks may be due to power of Garlics
    strength incapability of de-powering it

30
Garlic Rule Outs in Diagnosing ADHD
  • Seizure Disorder or other neurological issue such
    as Tourettes Syndrome
  • Specific Learning Disability
  • Vision acuity problem
  • Hearing problem
  • Metabolic problem
  • Genetic problem
  • Child Psychiatric Problem

31
Electroencephalography
  • Rule out epileptiform activity and/or epilepsy
    especially petit mal seizures which cause
    attention lapses
  • Use sleep deprived prolonged overnight EEG study
    to obtain all four stages of sleep (Tuchman,
    1994, 1997 Volkmar Nelson, 1990 Tuchman et al
    1998 Chez et al, 1997)
  • Use MRI if neurologic examination EEG or other
    clinical indicators suggest focal lesion (CAN
    1998)

32
Ophthalmologic Screening
  • Behavioral in focus
  • Pure formal visual screening
  • Rule out processing deficits
  • Rule out central nervous system abnormality

33
Audiological Screening
  • Rule out middle ear infection that causes
    intermittent hearing problems
  • Behavioral in focus
  • Pure formal tone audiometry
  • Brainstem auditory evoked potential if necessary
  • Rule out processing deficits
  • Rule out central nervous system abnormality

34
Metabolic Screening Tests
  • Rule out food allergies or nutritional problems
  • Metabolic Lab tests are indicated with signs of
    metabolic disease e.g. failure to thrive, small
    stature etc.
  • Quantitative amino acids
  • Urine organic acids
  • Uric acid calcium in a 24 hr urine
  • Thyroid studies

35
Cognitive, Speech Language, Motor, Sensory
Motor Planning
  • Pediatric Psychologist
  • Speech Language Pathologist
  • Occupational Therapist - sensory integration
  • Physical Therapist

36
Medication Treatment of ADHD
  • STIMULANTS
  • Ritalin-one dose lasts up to 4 hours
  • Metadate Ritalin once a day lasts up to 12
    hrs
  • Focalin New Ritalin derivative lasts up to 4
    hours
  • Attenade-Newest Ritalin derivative-lasts 6 hours
  • Concerta- once a day lasts up to 12 hours
  • Dexedrine-last 4 hours-spansule lasts 10 hours
  • Adderall- New Dexedrine - once or twice a day
    lasts longer than Ritalin
  • Cylert-requires liver function testing due to
    history of hepatic failure with children who were
    on it

37
Medication Treatment of ADHD
  • Non-Stimulant Medication
  • Strattera acts as a stimulant with similar side
    affects norepinephrine reuptake inhibitor not
    to be used with Prozac, Paxil or albuterol
  • Nutraceutical
  • Attend - a natural product which combines amino
    acids, fatty acids, lipid complexes, homeopathic
    medicines, hormone precursors to specific
    neurotransmitters

38
Plus these interventions
  • Parent Team
  • Home Modifications
  • Parent-Teacher Team
  • 504 Plan with Educational
  • Consistency of parent-teacher-doctor team
  • Unconditional love from all adults

39
Classroom Modifications for Students with ADHD
SLD
40
1. Classroom Modifications
  • Establish rules in classroom
  • Reinforce rules in classroom
  • Be consistent
  • Interact with student by eye contact, call name,
    finger on desk, touching
  • Place student in front, near positive peers, in
    low distracting areas

41
2. Classroom Modifications
  • Evaluate structure environment
  • Reduce external visual auditory stimuli
  • Repeat have student paraphrase directions
  • Give short directions
  • Use predetermined signals
  • Multiple modalities

42
3. Classroom Modifications
  • Natural logical consequences
  • Develop learning contracts with student
  • Use environmental clues prompts, steps, written
    lists, schedules
  • Demonstrate acceptable ways to communicate
    displeasure, anger, frustration pleasure

43
4. Classroom Modifications
  • Earphones study carrels
  • Reduced rote assignments
  • Longer time for testing
  • Read test to student
  • Assignment books organizers
  • Keep notebook for parent teacher communications
    after each class day

44
5. Classroom Modifications
  • Computer games programs
  • Peer Buddy Tutors Helpers
  • Classroom shadow, 1 on 1 Assistant
  • Progress notes to parents
  • Quarterly conferences with parents
  • Parents selection of teacher for next school year
  • Medications monitoring

45
6. Classroom Modifications
  • Unconditional love of child
  • Willingness to extend oneself
  • Openness to doing things differently
  • Working with parents as a team
  • Admitting when you are lost
  • Flexibility
  • Willingness to change

46
7. Classroom Modifications
  • Getting outside help
  • Openness to others input
  • Enthusiasm
  • Optimism - We Can Attitude
  • Determination to make it work
  • Commitment to process and to child
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