CHANCES ARE ITS NOT THE LIGHTS, A VITAMIN DEFICIENCY, SUGAR, OR RED DYE

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• CHANCES ARE ITS NOT THE LIGHTS, A
  VITAMIN DEFICIENCY, SUGAR, OR RED DYE 2
• Attention Deficit Hyperactivity Disorder
• Jan Deaton
• Trinity School
• Atlanta, GA
• jdeaton_at_trinityatl.org

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Attention and Learning

• May be relative to time/stage in life
• Few who are labeled are truly disabled
• Strengths are commonly overlooked
• Disorder is usually relative to expectations/
  styles

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A New View of ADDA Natural Adaptive Trait
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ADHD Myth No. 1

• It is a minor disorder - - - -
• 30 never finish high school
• 43 who are un-medicated are arrested
• Up to 50 of the prison population has ADD or LD
• 53 of ADD adults abuse substances
• 75 have interpersonal problems

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ADHD Myth No. 2

• Everybody outgrows ADD
• Research (11/07) brain may be immature in some
  up to 3 years behind
• At least 50 have symptoms into adulthood
• Medication can help everyone!

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ADHD Myth No. 3

• All people with ADHD have short attention spans
• Short attention spans ARE part of the disorder,
  BUT its only short for routine, everyday tasks

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School Problems

• Failure
• Underachievement
• Serious behavior problems
• Serious emotional problems
• Avoidance of school
• Dropping out - only 22 of students with ADHD
  enroll in college only 5 will graduate

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• Usually people with ADD dont recognize that THEY
  have a problem. They simply cannot do boring.
• You cant get them to do as requested unless you
  become furious with them you end up chronically
  angry.

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Senses

• People with ADD tend to hear, smell, see, feel
  and taste more than others.
• They are hypersensitive to environmental stimuli.
  Poor pre-frontal cortex activities cannot inhibit
  sensory information
• They need their clothes, food, room, etc. just
  right in order to feel comfortable and to focus.

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Time Issues

• They are frequently late
• It takes longer than predicted to do projects
• Their desks, book bags, rooms, files are messy
  and disorganized
• Projects are approached haphazardly with no
  organization
• They have many internal conversations

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Time

• They PROCRASTINATE
• There are multiple intentions, but projects are
  completed only as long as there is an interest

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Internal Supervision

• Many problems with long term goals
• The moment is what matters
• Crisis management approach to life
• Problems processing ideas, thinking through
  consequences before speaking/acting
• Consequences dont matter as much as they should

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Conflict Seeking

• Will argue just so the brain can be stimulated
• Must always have something going on

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ADHD Through Lifespan

• May have been colicky babies
• Hyperactive and hyper-sensitive
• Often not recognized in girls
• Short attention span
• Distractible
• Poor hand-writing
• Poor organization
• May have been bed-wetters

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Adolescents

• ADHD often unrecognized because hyperness has
  been outgrown
• Poor impulse control (pregnancy, substance abuse,
  runaways, legal problems, wrong crowd, driving
  problems)
• Often 3-5 years behind emotionally
• Excitement seeking
• Sleep problems

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Adults with ADHD

• Will often seek conflict with their ADHD child
• Frequent job changes
• Multiple relationships
• Move often (4 times more than others)
• Impulse control problems
• Driving issues
• Excitement seeking
• Sleep problems
• Alcohol induced violence (drink to settle down,
  but alcohol will cause violent brain to become
  more violent)

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Causes

• Genetics (Exacerbated by high fat/sugars, TV)
• Brain trauma (especially left frontal lobe)
• Prenatal toxic exposure
• Oxygen deprivation
• Brain infections
• Brain structure-new research suggests part of the
  brain works on beginning concentration and
  another works on distraction.

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New Research

• Neuroscientist, Earl Miller at MIT, The ability
  to willfully focus attention is physically
  separate in the brain from distracting things
  grabbing attention.
• This raises the possibility that we can fix
  problems independently.

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Diagnosing ADD

• Clinical history best tool
• Collateral information helpful (school, info
  from/about siblings, spouse, parents)
• Need to watch developmental course
• CAT scan is helpful, but not diagnostic
• Response to medication must be considered NOT
  true that, if a medicine is prescribed and it
  doesnt work, there is proof that ADD is not the
  problem
• Psychological testing helpful
• HEAD INJURIES DO MATTER
• Differentiating ADD from stress/abuse difficult,
  but must be considered
• Many with ADD have PTSS (do they put themselves
  in danger?)

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Brains of ADHD kids mature late

• From National Institute of Mental Health-11/07
• Lag can be as much as 3 years
• Affects brain areas that suppress inappropriate
  actions and thoughts, focus attention, remember
  things from moment to moment, work for reward and
  control movement
• May explain why some children outgrow
  ADHD-research ongoing to determine why some
  outgrow it and others do not
• Diagnosis cannot be made from brain scans yet

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ADD May look like

• Depression
• Bi-polar
• Aspergers Syndrome
• Substance abuse
• Verbal/Non-verbal LD
• Sleep apnea
• Thyroid disorder
• Chaotic environment
• LD
• PTSD

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• Motor cortex is only part of brain that matured
  faster in ADHD kids
• May account for restlessness and fidgety symptoms
• Slowest to mature
• Parts of front and side of brain that integrate
  information from sensory areas with the
  higher-order functions

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Parenting Strategies

• Set goals
• Bonding important
• Clear expectations
• Effective reinforcement of desired behaviors
• Discipline
• Supervision
• Resource New Skills for Frazzled Parents

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More

• Never helpful to allow children with ADD to look
  weird (hair, pierced body parts, clothes)-will
  hang with the group that is always willing to
  accept them when others may not
• Set rules Main one NO ARGUING
• Set special time aside-20 minutes/day to do
  something that the CHILD wants to do. No
  questions, no directions, no commands. Bond. Not
  a time to teach/time for emotional bonding

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More. . . .

• Set clear expectations
• Write rules down/post them (No more than 8)
• Assign jobs to do around the house (high self
  esteem/positive work habits built)
• Reward for everything they do that you ask
  notice it/hug them
• Decide on discipline ahead of time must be
  quick, clear, unemotional. Follow through.
• Supervised kids do best know where they are, who
  they are with. Check on them. So what if they get
  mad!

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Contributors to ADD or Exacerbated Conditions

• Lots of TV
• Sedentary life
• Simple carb diets
• Caffeine, especially with stimulants (decreases
  effect)
• Nicotine (blood flow decreases/ADD worsens)
• Video games deplete dopamine in brain and
  flashing may be concern (research ongoing)

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We need

• Education about ADHD
• Keeping of daily log while adjusting meds
• To start meds one at a time
• For doctors to write things down for patients
• For doctors to check perception of what was said
• To watch for changes when meds wear off
• To remember not to expect ADHD people to remember
  to take their meds
• To remember that everything is not the meds
• To teach chindren that they are NOT bad, stupid,
  or lazy

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Goal for Meds

• Best functioning
• Not necessarily off meds
• Best dose/not least dose

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Issues Involving Meds

• Some meds could be toxic for some
• Over diagnosing/over-prescribing
• Stimulants may cause tummy aches for 1-2
  weeks-taking kids off during week-ends/summers
  not necessarily good
• Starting about age 10 meds should be given all
  week increased risk of impulsive behaviors
  resulting in pregnancy, arrests, drug/alcohol
  abuse, etc.
• Stratera is a dirty drug because of side
  effects nausea, vomiting, new research suggests
  liver damage. (Dr. Daniel Amen)

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7 Common Reasons for Failure

• Not doing homework
• Forgetting assignments/tests
• Failing tests
• Not taking notes
• Transferring to a new school
• Co-existing condition not being treated
• Medications arent working

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Students may.

• not be able to attend and concentrate.
• have inconsistent and weak memories.
• have trouble learning to read, spell.
• be unable to produce written work.
• be confused mathematically.
• be disorganized and unable to plan.
• be disruptive.

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Learning/Attention Problems

• Terms generally negative
• Disorder Disability Deficit
• Same for entire spectrum
• Outcomes vary due to cause, reactions, responses
• Impact on self image, self fulfilling prophecies,
  happiness are generally not good

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ADHD Subtypes

• Predominantly Hyperactive-Impulsive
• Predominantly Inattentive
• Combined (most common)
• Dr. Daniel Amen 6 Subtypes
• Classic
• Inattentive ADD
• Over-Focusing ADD
• Limbic System Function
• Temporal Lobe Function
• Ring of Fire

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Classic ADHD

• Pre-frontal cortex problems
• Short attention span
• Disorganized
• Impulsive
• Procrastination
• Poor organization
• May be restless, in constant motion
• Confrontive/argumentative/conflict driven
• Treatment is usually stimulants (Ritalin,
  Adderol, etc.) since problem is with Serotonin
• Exercise is a must/intensive activity is best

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Inattentive ADD

• Spacey
• Daydreams
• Seems internally preoccupied
• Sense of self may be eroded by being put in
  situations where everyone but them gets it
• Treatment Stimulants in right dose or
  stimulating anti-depressants (Imipramine,
  Wellbutrin)

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Over-Focusing ADD

• Anterior Cingulate problems
• Lack of cognitive flexibility/unable to shift
  attention
• Holds grudges
• Stuck on thoughts/behaviors
• Addictive behaviors
• Oppositional/argumentative
• Pays too much attention/worries
• Appears selfish, but really inflexible
• Upset if things dont go their way
• Treatment Effexor first. Serolonergic enhancing
  medicines (Zoloft,Prozac,Paxil,Luvox) often with
  stimulants
• Diet should include less protein and both simple
  and complex carbs
• Need intense aerobic exercises
• People dealing with them must learn how to talk
  to them. They will argue and say no immediately

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Limbic System Function

• Moody sadness, irritability
• Negative thoughts
• Low motivation
• Finds little pleasure
• Sleep/appetite problems
• Social isolation
• Treatment Wellbutrin, Stratera, well balanced
  diet and exercise

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Temporal Lobe Function

• Emotional instability
• Memory problems
• Anxiety, feelings of panic, spaciness, confusion
• Physical problems headaches, abdominal pain
• Mild paranoia
• External/Internal aggression
• Learning problems
• Treatment Anti-convulsive
• TYPE OF MUSIC DOES MATTER!!!!!!!

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Ring of Fire

• May actually be bi-polar
• Typically easily distracted
• Very hyperactive
• Oppositional
• Moody
• Hyper-verbal
• Treatment Anti-convulsives (Neurontin, Depakote,
  Carbitrol, Topamax)

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Combination Types

• Typically aggressive
• Over-focused
• Common to have decreased prefrontal cortex,
  decreased temporal lobe activity, increased
  cingulate activity
• Any type of ADD can be combined
• Combined treatment often necessary

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Causes of Learning Behavior Differences/Disorder
s

• Differences in cerebral blood flow and
  carbohydrate metabolism
• Brain chemistry and structure and involved. Its
  the way we are biologically wired
• Learning and behavior disorders strongly
  inherited
• Once thought rarely due to brain damage, but new
  research suggests otherwise

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Two ways the brain pays attention1. Top down
willful, goal-oriented attention (ex.
reading)2. Bottom up reflexive attention to
sensory information (ex. loud noises, bright
colors, threatening animals, etc.
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Executive Function

• Research ongoing-term coined by Margaret Bridge
  Denckla says NOT a part of ADHD
• Attentional system involves not only the ability
  to focus and concentrate, but is also part of a
  larger group of complex behaviors called
  executive functions (initiating, goal setting,
  planning, pacing, priortizing, executing,
  inhibiting, sequencing, organizing, shifting
  flexibly, using feedback, self monitoring
• EF is refers to the planning and organizing
  complex tasks, managing working memory and mental
  flexibility, developing memory and organizational
  strategies, inhibiting responses, delaying
  gratification as well as grasping the gist of
  complex situations.
• Metaphor Conductor of an orchestra or fire
  captain
• Diagnostic Book bag or desk

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Exec. Function Affects

• Working memory and recall
• Activation, arousal, and effort
• Impulsivity
• Controlling emotions
• Internalizing language
• Taking an issue apart, analyzing the pieces,
  reconstituting and organizing it into new ideas

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ADHD Modifiers

• High interest activities
• Quiet environment
• Frequent positive feedback
• Novelty
• Illness
• Intimidation

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• Only 2 times for people with EF Now and not now
• Really Executive Dysfunction!

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Specific Pharmacoherapy

• Those with ADHD and without other problems
  Stimulants
• Those with ADHD with affective problems (anxiety,
  mood disorders, etc.) Antidepressants
• Special concerns CD in adolescents, need for Rx
  during p.m., presence of tics/TS
• About 90 respond to one or more of the above.
  Other meds may also be necessary.

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Dosages

• Typical dose 2x/day
• Study by National Institute of Mental Health
  (1998) suggests
• - medication 3x/day
• - nighttime dose about ½ size of first two
• - monitoring dosage closely
• - altering dose or changing drugs
• - daily behavioral report card from teachers

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Side Effects?

• In some cases loss of appetite, sleeplessness,
  rebound effect, tics
• Meds do not stunt growth
• Meds are not addictive
• Meds have the same effect on adolescents and
  adults

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• Meds are not a cure
• Psychostimulants are usual treatment for ADHD w/
  co-existing conditions
• Really dont stimulate student stimulate area
  of brain with insufficient neurotransmitters
• About 80 of students respond positively to meds
• Used for over 60 years

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Meds can

• Increase desired behaviors of attention, task
  completion, organization, self control
• Decrease problem behaviors of impulsivity, mood
  swings, non-compliance
• Improve social skills, handwriting, listening
• Approximately 80 of students show no
  
• symptoms of ADHD when medicated.

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• Gordons Principals Underlying Management of ADHD
• Seek the best in evaluation before you seek
• the best in treatment.
• All that is hyper is not hyperactivity all
  that is inattentive is not an attention deficit
  disorder
• Not every difference is a disorder
• Find a clinician who works closely with the
  school
• Dont let the pediatrician look at the childs
  angelic behavior and call you a hysteric (unless
  its true and you are)
• IQ tests and medication responses are not valid
  measures of ADHD (nor are most
  neurological tests).

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• Yes, Virginia, girls can have ADHD
• Theres no better treatment than accurate
  diagnosis
• Chances are its not the lights, a vitamin
  deficiency, sugar, or red dye 2
• There are no magic cures for ADHD
• If its done right, medication can truly help
• Too little treatment (medical or otherwise) has
  side effects
• Effective educational programming starts with
  acceptance of ADHD as a legitimate disorder that
  warrants special handling

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• Follow the universal rules for management of
  ADHD
• Educational strategies will be effective only if
  the setting allows for their implementation and
  if theyre sensible
• Theres nothing better than a good teacher
• Try to work it out so that the child wins-or at
  least has more than a snowballs chance
• Dealing with the ADHD child as a little criminal
  will get you nowhere
• Homework Beware the laws of diminished returns

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• Increase classroom structure any which way you
  can
• A limit in every garage, a consequence in every
  pot
• Hyperactive birds of a feather flock together
• Hyperactive children who succeed found an adult
  who really cared
• Keep your eyes on the prize

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In Sum

• Many academic and behavioral problems are
  neurobiologically based the result of ones
  wiring
• ADHD is not due to inadequate effort by the child
  or parent
• Behavioral and instructional planning need to be
  individualized to the childs strengths and
  weaknesses/he may qualify for special education
• There is a complex interaction between people
  and their environment nurturing is
  important!!!

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The Starfish

• There was a young man walking down a deserted
  beach just before dawn. In the distance he saw a
  frail, old man. As he approached the old man he
  saw him picking up stranded starfish and throwing
  them back into the sea. The young man gazed in
  wonder as the old man again and again threw the
  small starfish from the sand to the water. He
  asked, Old man, why do you spend so much energy
  doing what seems to be a waste of time?
• The old man explained that the stranded starfish
  would die if they were left in the morning sun.
• But there must be thousands of beaches and
  millions of starfish! exclaimed the young man.
  How can you make any difference?
• The old man looked down at the small starfish in
  his hand and, as he threw it to the safety of the
  sea, said, I make a difference to this one.