questionquestion

Do you have a parent organization? Do you have a parent organization?

WHO IS GUILTY?WHO IS GUILTY?

This is what you may hear from your close This is what you may hear from your close environment:environment:

The child is healthy – nevertheless there The child is healthy – nevertheless there are problems, how is that?are problems, how is that?

When the child is involved in an accident –When the child is involved in an accident –(for instance has taken(read: drinking) (for instance has taken(read: drinking) toxins) you are guilty toxins) you are guilty

You do not provide structure the child You do not provide structure the child needsneeds

Research of Russ Barkley and Research of Russ Barkley and CunninghamCunningham

OBSERVATIONAL STUDIES INDICATE OBSERVATIONAL STUDIES INDICATE THAT MOTHERS ARE ACTING IN A THAT MOTHERS ARE ACTING IN A NEGATIVE WAY TOWARDS THEIR NEGATIVE WAY TOWARDS THEIR CHILD WITH ADHD: THEY ARE CHILD WITH ADHD: THEY ARE COMMANDING, VOICE MUCH COMMANDING, VOICE MUCH CRITICISMCRITICISM

WHAT IS THE DIRECTION? WHAT IS THE DIRECTION?

MOTHER - CHILDMOTHER - CHILD

TEST: THE DUO HAD TO RESOLVE TEST: THE DUO HAD TO RESOLVE PROBLEMS – THEY HAD TO WORK AS PROBLEMS – THEY HAD TO WORK AS A TEAMA TEAM

WHEN CHILD WAS ON MEDICATION WHEN CHILD WAS ON MEDICATION (METHYLPHENIDATE) THE MOTHER (METHYLPHENIDATE) THE MOTHER WAS ACTING LESS NEGATIVEWAS ACTING LESS NEGATIVE

CONCLUSIONCONCLUSION

CONCLUSIONCONCLUSION

NEGATIVE BEHAVIOR EMANATES NEGATIVE BEHAVIOR EMANATES FROM THE ADHD CHILDFROM THE ADHD CHILD

STROES ALBERTS AND VAN STROES ALBERTS AND VAN DER MEERE. JAACP (2004)DER MEERE. JAACP (2004)

CHILD WITH ADHD – STUDENTCHILD WITH ADHD – STUDENT

SPONTANEOUS BEHAVIOR OF THE SPONTANEOUS BEHAVIOR OF THE STUDENTSTUDENT

CHILD TRIGGERED STRUCTURE CHILD TRIGGERED STRUCTURE PROVIDING BEHAVIOR IN THE PROVIDING BEHAVIOR IN THE STUDENT IN LESS THAN A MINUTE STUDENT IN LESS THAN A MINUTE

WHAT MAKES THE CHILD WITH WHAT MAKES THE CHILD WITH ADHD SO VULNERABLE?ADHD SO VULNERABLE?

1) HE/SHE LOOKS HEALTHY1) HE/SHE LOOKS HEALTHY

2) PERFORMANCE FLUCTUATES2) PERFORMANCE FLUCTUATES

3) HE CAN WHEN HE WANTS3) HE CAN WHEN HE WANTS

DEFINITION OF ADHDDEFINITION OF ADHD

FLUCTUATIONS IN STATE IS CHILD’S FLUCTUATIONS IN STATE IS CHILD’S TRAITTRAIT

READING – BRAINREADING – BRAIN CLUMSINESS – BRAINCLUMSINESS – BRAIN MOTIVATION – BRAIN (GUILTY?) MOTIVATION – BRAIN (GUILTY?)

COMORBIDITYCOMORBIDITY

Motivation versus cognitive deficitMotivation versus cognitive deficit

ADHD – Oppositional Defiant DisorderADHD – Oppositional Defiant Disorder Conduct DisorderConduct Disorder

- Learning disabilities - Learning disabilities

extra effort

no extra effort

optimal state non-optimal state

Perf

orm

an

ce

Actual state vs. required (target) state – effort allocationActual state vs. required (target) state – effort allocation

Theory of state regulationTheory of state regulationVan der Meere (2005) In Gozal & Molfese Van der Meere (2005) In Gozal & Molfese ADHD: ADHD: from genes to patientsfrom genes to patients Totowa NJ Humana press) Totowa NJ Humana press)

Signal rate Signal rate

05

101520253035404550

fast slow

ADHDControlsothers

Controls > ADHD: Fast Go Correct ADHD > Controls: Fast Go Correct

Controls > ADHD: Slow Go Correct ADHD > Controls: Slow Go Correct

Controls > ADHD: Slow NoGo Correct ADHD > Controls: Slow NoGo Correct

NRT is a neural sheet draped over the lateral/anterior aspects of the thalamus

NRT is the functional interface between the arousal and attention systems

Receives axonal collaterals from corticothalamic, thalamocortical and reticular formation projections

Nucleus Reticularis Thalami

Portas et al. 1998, J. of Neuroscience, 18

Stress response defined in terms of Stress response defined in terms of occurrence of facial movementsoccurrence of facial movements

Lips Part Jaw drop

Lip Pressor Lip Suck

Van der Meere, BVan der Meere, Böörger, & Wiersema (submitted)rger, & Wiersema (submitted)

Gemiddelde frequentie lipspart

Periode

654321

Aa

nta

l

30

20

10

0

groepscode

Controle

ADHD

Mean frequency facial movements

jjjjjjjjjjjj

group

Time on task

conclusionconclusion

ADHD associated with poor state ADHD associated with poor state regulation (underactivation) : in common regulation (underactivation) : in common parlance “poor motivation.parlance “poor motivation.

More research needed on factors that More research needed on factors that regulate energy metabolism in ADHD regulate energy metabolism in ADHD

IN THE MEANTIME IN THE MEANTIME

RESEARCH INDICATED THAT THE RESEARCH INDICATED THAT THE SEVERITY OF THE ADHD SYMPTOMS SEVERITY OF THE ADHD SYMPTOMS IS RELATED TO STRESS IS RELATED TO STRESS EXPERIENCED BY PARENTSEXPERIENCED BY PARENTS

See: Anastopoulos et al (1992). Parenting See: Anastopoulos et al (1992). Parenting stress among families of children with stress among families of children with ADHD. Journal of Abnormal Child ADHD. Journal of Abnormal Child Psychology, 20, 503- 520. Psychology, 20, 503- 520.

Stress in familiesStress in families

Symptom Checklist 90-Revised Symptom Checklist 90-Revised (Derogatis, 1983). Manual for the SCL-90. (Derogatis, 1983). Manual for the SCL-90. Baltimore, MD.Baltimore, MD.

90 items 5 point scale 90 items 5 point scale Depression and somatic complainsDepression and somatic complains

Reduce stressReduce stress

Family therapy/ parent training – it leads to Family therapy/ parent training – it leads to an increase in parenting self-esteem and an increase in parenting self-esteem and reductions in overall stressreductions in overall stress

Behavioral management principles Behavioral management principles

Take breaks Take breaks