Attention Deficit Disorders ADD

1
(No Transcript)
2
Attention Deficit Disorders (ADD)

• Constitutes a chronic neurobiological condition
  characterized by developmentally inappropriate
  attention skills, impulsivity, and in some cases,
  hyperactivity.
• Estimated 3-5 of school population (2 million
  children/adolescents)
• Approximately 50 continue to struggle with ADD
  as adults

3
Other Diagnostic Criteria

• Onset of symptoms occurs no later than 7 years of
  age.
• Symptoms are present in two or more situations
  (school, home, work)
• Disturbance causes clinically significant
  distress or impairment in social, academic, or
  occupational functioning.
• Symptoms have been present for the past 6 months.

4

• Elementary Aged Child
• An 11-year old left the following note of
  explanation for his mother.
• I am sorry for using the baseball bats the wrong
  way next time Ill use a flyswatter (which I was
  untilthe flyswatter wasnt strong enough so I
  used a bat when the fly landed on the window. I
  didnt even think first not to hit the fly there
  I just hit it as a result the window smashed down
  to the ground!
• I am definitely sorry.

5
Symptoms of ADD(The list is prepared in
descending order of discriminating power.)

• Often fidgets with hands or feet or squirms in
  seat.
• Has difficulty remaining seated when required to
  do so.
• Is easily distracted by extraneous stimuli.
• Has difficulty waiting turn in games or group
  situations.
• Often blurts out answers to questions before they
  have been completed.

6

• Has difficulty following through on instructions
  from others (not because of oppositional behavior
  or failure to comprehend)
• Has difficulty sustaining attention in teaching
  or play activities.
• Often shifts from one uncompleted activity to
  another.
• Has difficulty playing quietly.
• Often talks excessively.
• Often interrupts or intrudes on others.
• Often does not seem to listen to what is being
  said.

7

• Often loses things necessary for tasks or
  activities at school or at home.
• Often engages in physically dangerous activities
  without considering possible consequences.

8
ADHD 

• A student with other health impairments has
  limited strength, vitality, or alertness,
  including a heightened alertness with respect to
  the educational environment, that is due to
  chronic or acute health problems such as asthma,
  attention deficit disorder or attention deficit
  hyperactive disorder, diabetes, epilepsy, a heart
  condition, hemophilia, lead poisoning, leukemia,
  nephritis, rheumatic fever, and sickle cell
  anemia, and
• Adversely affects a childs educational
  performance, (34 Code of Federal Regulations,
  300.7)

9

• Heightened sense of alertness to the environments
  allows students with AD/HD to be served under the
  category.
• IDEA doesnt specifically define AD/HD most
  professionals abide by the APA definition.
•  
• The essential feature of
• Attention-Deficit/Hyperactivity Disorder is a
  persistent pattern of inattention and/or
  hyperactivity/impulsivity that is more frequently
  displayed and severe than is typically observed
  in individuals at a comparable level of
  development.

10

• Frequency and severity are the limiting
  criterion.
•  
• For APA diagnosis of AD/HD symptoms must manifest
  before age 7 and last more than 6 months. And
  present in at least two settings.

11

• Predominately inattentive type (IN)
• Trouble paying attention in class and are
  forgetful, and easily distracted.
• Sometimes referred to as ADD

12

• Often appear lethargic, apathetic, or hypoactive.
  Tend to be internally focused  
• Minds may be hyperactive while bodies appear to
  be in slow motion
• Tend to demonstrate problems with word/concept
  retrieval/recall.
• Symptoms may appear later (8-12)
• Daydreamers

13
Predominately hyperactive-impulsive(HI)

• Includes students who cannot sit still.
• Often talk excessively and difficulty playing
  quietly.
• May have difficulty with bedwetting, sleep
  problems, stubbornness, and temper tantrums.
• Tend to be more accident prone,
  injuries/poisonings
• Relatively few adolescents and adults with ADHD
  classify as having only HI

14

• Most often have features of inattention
• Primarily HI however, can become workaholics
• Brutally frank
• Blurt out impulsive comments
• Interrupt conversations

15

• Combined type (CB)
• ADHD without slash
• As many as 85 fall into this category
• Barkley suggests that IN of AD/HD may have
  focused or selective attention as a core problem
  while HI and CB have poor goal-directed
  persistence and interference control as the core
  of their problem.

16

• IN might have difficulty starting a task and
  finishing assignments, while CB may start
  immediately but find completing the task
  difficult b/c of distractions.

17
(No Transcript)
18
(No Transcript)
19
(No Transcript)
20
(No Transcript)
21
(No Transcript)
22
(No Transcript)
23
(No Transcript)
24
(No Transcript)
25
(No Transcript)
26
(No Transcript)
27
(No Transcript)
28

• The symptoms do not occur exclusively during the
  course of a Pervasive Developmental Disorder,
  Schizophrenia, or other Psychotic, Disorder, and
  are not better accounted for by another mental
  disorder (e.g., Mood Disorder, Anxiety Disorder,
  Disassociative Disorder, or a Personality
  Disorder).

29

• Code Based on Type
• 314.01 Attention-deficit/hyperactive disorder,
  combined type if both criteria A1 and A2 are met
  for the past six months.
• 314.00 Attention-deficit/hyperactivity Disorder,
  Predominately Inattentive Type if criterion A1
  is met but criterion A2 is not met for the past
  six months.
• 314.01 Attention-deficit/hyperactive disorder.
  Predominately Hyperactive-Impulsive Type if
  criterion A2 is met but Criterion A1 is not met
  for the past six months.
• Page 167 figure 6-2 Differences b/t inattentive
  and hyperactive-impulsive types of AD/HD

30

• Conceptual model of self-regulation
  characteristics
• 4 executive functions
•  
• Low self-esteem
• Conduct disorders
• Delinquency
• Poor grades
• Dropping out
• Employment problems
• Interpersonal difficulties

31

• 1.  Nonverbal working memory - allows students to
  retrieve auditory, visual, and other sensory
  images of the past. Deficits in this area can
  cause students to have difficulty learning from
  past experience.
• 2.  Internalized speech
• 3.  Self-regulation of affect, motivation, and
  arousal trouble with goal-directed action (e.g.,
  study for important test vs. going to party)
• 4.  Reconstitution analyzing and synthesizing
  behavior (e.g. long term assignmentdone the
  night before it is due)

32

• Figure 6-3 page 170
• Summary of impairments likely to be associated
  with AD/HD

33

• Identifying Causes -Environments
• Many have been discounted by research including
• Too little or too much sugar
• Aspartame
• Food sensitivities
• Food additives/coloring
• Lack of vitamins
• Television
• Video games
• Yeast
• Lightning
• Fluorescent lighting
• Allergies
• Poor parenting 

34

• Biological
• Teratogens increase likelihood
• Prenatal exposures
• Peri and postnatal trauma
• Injuries
• Infections
• Iron deficiency anemia
• Exposure to toxins
• Account for 20 to 30 of AD/HD in boys less in
  girls
• Continuum greater severity with environmental
  considerations vs. genetic

35

• Brain differences
• Resent research indicates failure in the brain
  circuitry underlying inhibition and self-control.
• Inability to inhibit their impulses to input.
• Inability to learn from experience
• Part of the cerebellum, the prefrontal cortex,
  and the basal ganglia. noticeably smaller in
  persons with AD/HD (especially on the right
  side) smaller overall brain volume
• 1990s study found poor conversion of glucose to
  energy on the right side as efficiently as others
  

36

• different types of AD/HD may stem from different
  cause
• IN more likely to have disturbances in early
  responses to sensory input according to EEGs
  (might explain why starting a task is
  particularly difficult)
• CB more likely to demonstrate disturbances in
  later stage (might be more difficulty while
  completing a task)

37

• CB might be divided into two subgroups
• Poor inhibitory control
• Poor inhibition regarding delay of reward
• IN might be divided into two subgroups
• Hypo or under arousal
• maturational lag of central nervous system
• Persons with AD/HD are more likely to prefer
  visualization

38

• Genetics
• Appear to play a role, more so with some types
• Twins studies in 2001
• Identical (monozygotic) twins are twice the
  concordance rates (60 to 80)
• fraternal (dizygotic) twins (20 to 30)
• CONTINUUM based
• Prevalence 3 to 7 of school age children has
  AD/HD (APA 2000)
• Estimates vary greatly because of interpretations
  of criteria for diagnosis

39

• ID is increasing dramatically
• Heightened awareness
• Improved diagnostic practices
• Societal changes that require more structure and
  concentrations
• Ratio of boys to girls is 9 to 3

40

• DSM-IV study in 1995
• 55 are diagnoses with CB (girls diagnosed have
  more severe characteristics than the boys
  diagnosed)
• 27 had IN (contained the most girls)
• 18 had HI (contained the most young children 4
  to 6 years old)
• vast majority of children identified are
  euro-American
• 2/3rds with AD/HD have coexisting - especially
  oppositional defiant disorder and conduct
  disorders

41

• 50 of young children with AD/HD also have
  speech/language disorders
• Children with coexisting situations must have
  symptoms that are excessive for his or her mental
  age rather than chronological age.

42

• Initial diagnosis
• Involves pediatrician
• Psychologist
• Or psychiatrist
• Medical Examination
• Clinical Interview
• Teacher and Parent Rating Scales

43

• Teachers should never suggest a child needs
  medication!!!!!!
•  
• However, research shows that they benefit from RX
• RX alone shown to be better than just behavioral
  therapy but the best is combination of the two.
• RX hard for some kids to tolerate

44

• Figure 6-5
• Research is linking RX to brain activity
• Type and severity of AD/HD effects educational
  performance and whether Special education is
  needed
•  

45

• Not every child with AD/HD qualifies for IDEA
• Many can function well in the classroom with
  accommodations
• Extra time
• Preferred setting
• Peer note taker
• Oral tests

46

• RX
• Psychostimulants
• Stimulate or activate neurological functioning
• (paradoxical effect)
• Methylphenidate or Ritalin
• Adderall
• Rebound Effect

47

• Section 504 of ADA prohibits discrimination
  against students with AD/HD or other disabilities
  if their disabilities substantially limit one or
  more of their major life activities.
• 504 Plan a school team decides what
  accommodations are necessary. Parent and student
  participation is not mandated but is better
• Accommodations page 181

48

• Infancy
• Less reliable
• Negative-new
• Negative mood
• Intensity
• Sleeping
• Eating
• Odd vocalizations

49

• Age 2-3
• 60-70 by 2-3
• Non-compliant
• "On the go"
• Accidents
• Naps stop
• Demands attention
• Childproofing needed
• Jealousy

50

• Age 3-5
• Public non-compliance
• Peer problems
• School calls
• Discipline problems
• Conscience problems
• Destructive

51

• Age 5-12
• School complaints
• Retention
• L.D. emerges
• Fights
• Acting out
• Lying
• Theft
• Self-esteem drops

52

• Adolescence
• Hyperactivity decreases
• Peer problems
• Truancy
• Academics behind
• Family fed up
• Arguments
• Depression
• Car (not good)
• Chemical abuse?

53

• Adults
• DO EXIST
• Relief from school
• Residual symptoms
• Contact with law decreases
• More divorce, job changes, moves
• Education-economic lower
• Some ADD assets
• Psycho. Contact

54
(No Transcript)
55
(No Transcript)