ADHD (attention deficit hyperactivity disorder)

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ADHD(attention deficit hyperactivity disorder)

• Lynn Nelson
• EEX 5051
• University of Central Florida
• June 2009

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The Story of Fidgety Phil Poemcredited as being
the earliest literary reference to ADHD

• Let me see if Phillip can, be a little gentleman.
  
• Let me see, if he is able, to sit for once at
  table Thus Papa bade Phil behave and Mamma
  lookd very grave.
• But fidgety Phil, He wont sit still he wiggles
  and giggles,
• And then, I declare Swings backwards and forwards
  and tilts up his chair,
• Just like any rocking horse Phillip I am
  getting cross!
• -Heinrich Hoffmann 1865
• Source Hallahan, Kuffman, Pullen (2009),
  Chapter 7, Learners with Attention Deficit
  Hyperactivity Disorder, Exceptional Learners, An
  Introduction to Education, Ed.11, (pg 223),
  Boston Allyn and Bacon.

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History

• 1865 Physician Heinrich Hoffmans Fidgety Phil
  poem. Followed later with poem called Johnny
  Head-in-the-Air
• 1902 Royal College of Physicians of London,
  Dr George F. Still delivered three lectures
  concerning children he referred to as having
  defective moral control.
• Source Hallahan, Kuffman, Pullen (2009),
  Chapter 7, Learners with Attention Deficit
  Hyperactivity Disorder, Exceptional Learners, An
  Introduction to Education, Ed.11, (pg 225),
  Boston Allyn and Bacon.

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Psychological History

• Goldsteins Brain Injured Soldiers of WW I
  1936 Kurt Goldstein developed preservation
  model tendency to repeat same behaviors
  forced responsiveness to stimuli Ground
  distraction.
• The Strauss Syndrome late 1930s early 1940s
  Heinz
  Werner Alfred Strauss distractibility.
• Cruickshanks Work 1950s minimally brain
  injured criteria for those whom meet todays
  criteria for ADHD.
• Minimal Brain Injury 1950s Brain pathology
  oriented.
• Hyperactive Child Syndrome1960s marks a more
  definitive approach away from Brain oriented
  subtleties.
• Source Hallahan, Kuffman, Pullen (2009),
  Chapter 7, Learners with Attention Deficit
  Hyperactivity Disorder, Exceptional Learners, An
  Introduction to Education, Ed.11, (pp 226-227),
  Boston Allyn and Bacon.

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Defining ADHD

• Definition ADHD
• Attention deficit hyperactivity disorder
• A condition characterized by severe problems of
  inattention, hyperactivity, and/or impulsivity
  often found in people with learning disabilities.
• Source Hallahan, Kuffman, Pullen (2009),
  Glossary, Exceptional Learners, An Introduction
  to Education, Ed.11, (pg 565), Boston Allyn and
  Bacon.

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DEFINITION

• Attention-deficit/hyperactivity disorder (AD/HD
  or ADHD) is a neurobehavioral developmental
  disorder.
• It is the most commonly diagnosed psychiatric
  disorder in children affecting about 3 to 5 of
  children globally with symptoms starting before
  seven years of age.
• It is characterized by a persistent pattern of
  impulsiveness and inattention, with or without a
  component of hyperactivity.
• ADHD is diagnosed twice as frequently in boys as
  in girls, though studies suggest this discrepancy
  may be due to subjective bias.
• SOURCE http//en.wikipedia.org/wiki/Attention-def
  icit_hyperactivity_disorder

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DEFINITION contd.

• ADHD is generally a chronic disorder with 30 to
  50 of those individuals diagnosed in childhood
  continuing to have symptoms into adulthood
• As they mature, adolescents and adults with ADHD
  are likely to develop coping mechanisms to
  compensate for their impairment
• SOURCE http//en.wikipedia.org/wiki/Attention
  deficit_hyperactivity_disorder

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SIGNS SYMPTOMS

• Common ADHD symptoms include inattentive,
  hyperactive, and impulsive behavior
• ADHD symptoms can affect children all day and
  every day
• ADHD can affect a child's ability to focus, sit
  still, and follow instructions
• The symptoms of ADHD can also affect a child's
  social interactions with others

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What Causes ADHD

• http//video.about.com/add/ADHD.htm
• The Brain
• Frontal Cortex An interconnected combination
  of nerve cells believed responsible for ATTENTION
• Neurons- Neurotransmitters Neuroreceptors
  communicate through chemical reactions conducted
  over synapse
• Chemical transmitter Dopamine regulates Behavior
• This model follows and example that indicates
  that there is a genetic deficiency of some
  neurotransmitters
• Source Hallahan, Kuffman, Pullen (2009),
  Chapter 7, Learners with Attention Deficit
  Hyperactivity Disorder, Exceptional Learners, An
  Introduction to Education, Ed.11, (pg 234),
  Boston Allyn and Bacon.

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ADHD Vocabulary

• Disinhibition The ability to repress thoughts
  or actions that may be socially inappropriate.
• Inhibitory Responses Activity in the brain that
  tells us what is appropriate to think and say
  THINK IT BUT DONT SAY IT!
• ON THE MINDOUT THE MOUTH
• Impulsivity if I cant do it right Ill do it
  fast
• Consequential Thought
• Source LaVoie, Richard Developer/Presenter,
  Gunther, Noel Producer, Camp, Joseph Director
  (1994), Last One Picked, First One Picked On,
  video, United States, Greater Washington
  Educational Television Association

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The Casual Theories ADHD

• Myths
• Sugar Hyperactivity associated to environment.
• Video Games Unproven in research studies.
  Perhaps more effective way of controlling
  behavior.
• Artificial Food Colorings and Diet
  Unsubstantiated results generated though blind
  testing.
• Source Hallahan, Kuffman, Pullen (2009),
  Chapter 7, Learners with Attention Deficit
  Hyperactivity Disorder, Exceptional Learners, An
  Introduction to Education, Ed.11, (pg 233),
  Boston Allyn and Bacon.

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Hereditary and Environmental Factors

• Family Studies ADHD being passed along
  percentages Parent to child 57 Sibling risk
  is about 32
• Twin Studies Indicate that generally more common
  in identical twins than fraternal twins.
• Molecular Genetic Studies Unlikely that a
  single gene is responsible for ADHD, but more
  likely a combination of several genes.
• Toxins and Medical Factors Evidence does show
  relationship between toxins and birth defects.
• Source Hallahan, Kuffman, Pullen (2009),
  Chapter 7, Learners with Attention Deficit
  Hyperactivity Disorder, Exceptional Learners, An
  I introduction to Education, Ed.11, (pp 235-236),
  Boston Allyn and Bacon.

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Is there a treatment?

• Parents need to be proactive about how to
  effectively manage their child's ADHD symptoms
• Once ADHD is diagnosed it is generally the
  childs pediatrician that will institute a tailor
  made individual treatment plan
• Many Doctors use stimulant drugs as the most
  commonly prescribed medication to treat ADHD
• Stimulants have a calming effect on children with
  ADHD

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Treatment contd.

• Schools may have have their nurses dispense ADHD
  medication that is prescribed by a students
  pediatrician, once a copy of the original
  prescription is kept on file
• Information about the students ADHD medication is
  also listed in the childs IEP and this record is
  kept confidential

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What ADHD is and is not

• ADHD is not a reflection of a childs
  intelligence or the result of poor parenting
  skills
• It is a condition of the brain that makes it
  difficult for children to focus, pay attention,
  and control their behavior
• ADHD is a real and treatable medical condition
  and it is estimated that it affects over 5
  million children in the United States alone

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Stimulants and Sudden Death

• A study examining stimulant use among children
  and adolescents found an association between
  stimulants and sudden unexplained death in youth
  with no evidence of pre-existing heart disease.
• Attention must be paid the the fact that although
  the potential risk of exposing children to
  stimulant medications sudden death may be a rare
  occurrence but it does occur.
• Source http//www.nimh.nih.gov/science-news/2009/
  questions-raised-about-stimulants-and-sudden-death
  .shtml

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Cost benefit analysis

• The results of the study draw attention to
  concerns that stimulant medications increase the
  risk of sudden unexplained death in children and
  adolescents
• According to an editorial, by coauthors Benedetto
  Vitiello, M.D. and Kenneth Towbin, M.D., both at
  NIMH, they point out that the study they
  conducted on stimulant medications and sudden
  death occurrences, could not provide information
  on whether ADHD itself could increase the risk of
  sudden death, or its association with high-risk
  behaviors such as substance abuse
• Vitiello, B. and Towbin, K. Stimulant treatment
  of ADHD and risk of sudden death in children.
  Retrieved June 19, 2009 from American Journal of
  Psychiatry AIA1-10, 2009.

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Benefit vs. Risk Assessment

• The editorial went on to note that while
  randomized prospective studies are not
  practicalgiven the large numbers of subjects
  needed to detect such rare eventsadditional
  case/control studies would still be informative.
  In addition, research to improve screening
  methods for heart conditions that raise the risk
  of sudden death is essential.
• Gould, M.S., Walsh, T., Munfakh, J.L., Kleinman,
  M., Duan, N., Olfson, M., Greenhill, L, and
  Cooper, T. Sudden death and use of stimulant
  medications in youth. Retrieved June 18, 2009,
  from American Journal of Psychiatry AIA1-10,
  2009

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FINDINGS

• The editorial notes the following
• "1) sudden unexplained death is a rare event
• 2) this is only the first such study
• 3) it relies on small numbers
• 4) it is not possible to quantify the risk beyond
  estimating that it is very small.
• Source Gould, M.S., Walsh, T., Munfakh, J.L.,
  Kleinman, M., Duan, N., Olfson, M., Greenhill, L,
  and Cooper, T. Sudden death and use of stimulant
  medications in youth. Retrieved June 18, 2009,
  from American Journal of Psychiatry AIA1-10,
  2009

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Special Education and ADHD

• Section 504 of the Rehabilitation Act of 1973 and
  the Individuals with Disabilities Education Act
  (IDEA) are laws that have been enacted to ensure
  that children with disabilities, including ADHD,
  receive an appropriate education
• www.chadd.org

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Is there a cure for ADHD?

• Currently there is no cure for ADHD
• Brain research is ongoing to learn more about the
  role of the brain in the cause of ADHD
• Symptoms of ADHD can be effectively managed with
  treatment regimens
• ADHD continues into adolescence and adulthood in
  many cases
• Approximately 80 percent of children who need
  medication for ADHD may still need it as
  teenagers
• Treatment programs that include medication and
  behavioral therapy can help a child manage their
  ADHD symptoms

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How does ADHD manifest in a childs daily life?

• When a child displays a persistent pattern of
  inattention and hyperactive, impulsive behavior
  that occurs more frequently and more severely
  than other children of similar age, it is assumed
  their condition is caused by ADHD

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ADHD Education and Support

• The more information you know about ADHD, the
  better you are equipped to offer guidance to
  others who have questions
• When school professionals understand how ADHD
  affects a student's life, they can play a key
  role in developing strategies to help children
  manage the everyday challenges they face

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The Federal Mandate

• United States Department of Education Your
  child's rights under federal laws designed to
  ensure that children with disabilities, including
  ADHD, receive an appropriate education
• Source http//www.ed.gov/offices/OSERS/Policy/IDE
  A/index.html

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ADHD Resources (for education and support)

• American Medical Association (AMA) - This
  professional organization for doctors is
  dedicated to the art and science of medicine and
  promoting public health. http//www.ama-assn.org
• CHADD.org - Children and Adults with Attention
  Deficit/Hyperactivity Disorder (CHADD) is a
  national nonprofit organization that provides
  advocacy and support for people with ADHD.
  www.chadd.org

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ADHD Resources (for education and support)
contd.

• ADDitude Magazine - Stay on top of the latest
  information about ADHD in children, adolescents
  and adults. http//www.additudemag.com
• The Mayo Clinic - The Mayo Clinic is dedicated to
  the diagnosis and treatment of virtually every
  type of complex illness, including ADHD.
  http//www.mayoclinic.com

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ADHD Resources (for education and support)
contd.

• NIMH.NIH.gov - The National Institute of Mental
  Health provides useful information about ADHD in
  children, adolescents and adults.
  http//www.nimh.nih.gov
• Learning Disabilities Association of America
  (LDA) - LDA is one of the largest non-profit
  volunteer organizations advocating for
  individuals with learning disabilities.
  http//www.ldanatl.org

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REFERENCES

• Hallahan, Kuffman, Pullen (2009), Chapter 7,
  Learners with Attention Deficit Hyperactivity
  Disorder, Exceptional Learners, An Introduction
  to Education, Ed.11, (pp 223-257), Boston Allyn
  and Bacon.
• Cox DJ, Merkel RL, Moore M, Thorndike F, Muller
  C, Kovatchev B. Relative benefits of stimulant
  therapy with OROS methylphenidate versus mixed
  amphetamine salts extended release in improving
  the driving performance of adolescent drivers
  with attention-deficit/hyperactivity disorder.
  Retrieved June 18, 2009, from Pediatrics, 2006
  Sept 118(3)e704-e710.
• http//en.wikipedia.org/wiki/Attention-deficit_hyp
  eractivity_disorder. Retrieved June 17,2009, from
  Wikipedia
• Linnet KM, Dalsgaard S, Obel C, Wisborg K,
  Henriksen TB, Rodriguez A, Kotimaa A, Moilanen I,
  Thomsen PH, Olsen J, Jarvelin MR. Maternal
  lifestyle factors in pregnancy risk of
  attention-deficit/hyperactivity disorder and
  associated behaviors review of the current
  evidence. Retrieved June 18, 2009, from American
  Journal of Psychiatry, 2003 Jun
  160(6)1028-1040.

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REFERENCES contd.

• http//www.nimh.nih.gov/health/publications/nimh-p
  ublications.shtml. Retrieved June 17, 2009, from
  NIMH National Institute of Mental Health, 2009.
• http//www.nimh.nih.gov/science-news/2009/question
  s-raised-about-stimulants-and-sudden-death.shtml.
  Retrieved June 17, 2009, from NIMH National
  Institute of Mental Health, 2009.
• LaVoie, Richard Developer/Presenter, Gunther,
  Noel Producer, Camp, Joseph Director (1994),
  Last One Picked, First One Picked On, video,
  United States, Greater Washington Educational
  Television Association

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Comedian Steven Wright on ADHD

• "I was trying to daydream but my mind kept
  wandering.

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Classroom Exercise Links

• http//quiz.healia.com/
• http//video.about.com/add/ADHD.htm