Who am I? Katherine McGavern Founding Board member of CHADD Princeton- Mercer County CHADD-Certified Parent to Parent Teacher Member of Editorial Advisory Board of Attention magazine Graduate, Fast Track Coaching Academy ADHD Coach for College Students and Adults Data Sources CHADD Parent to Parent Course in ADHD Education (illustrated slides) Chris Zeigler-Dendys Presentation on Executive Function Deficits at CHADDs 20 th annual conference, Oct 2007 (text only slides). Peg Dawson and Richard Guares Executive Skills in Children and Adolescents A practical guide to assessment and intervention. Sandra Reifs The ADHD Book of Lists A practical guide for helping Children and Teens with Attention Deficit Disorders Attention Magazine: Understanding the link between Executive Functions and school success, February 2008 author: Chris Zeigler Dendy. Dr. Ari Tuckman, More Attention Less Deficit, Success Strategies for Adults with AD/HD. Website adultadhdbook.com What will we look at tonight Some ADHD MYTHS Some important ADHD FACTS The physiology of ADHD Executive Functions and ADHD How is ADHD Diagnosed? Treatment options for ADHD Common ADHD Myths MYTH: AD/HD isnt REAL MYTH: AD/HD is a result of poor parenting or a permissive Society MYTH: AD/HD is a disorder for boys only MYTH: AD/HD is over-diagnosed MYTH: AD/HD is an excuse for laziness, carelessness, and a bad attitude Its a Fact: ADHD is REAL AD/HD is a real neurobiological disorder that has been scientifically researched and documented. It is recognized as an impairing disorder by: U.S. Department of Education National Institutes of Health U.S. Congress U.S. Centers for Disease Control and Prevention U.S. Surgeon General All major medical, psychiatric, psychological and educational associations ADHD in History One of the best-researched disorders in medicine Medical Science first documented the disorder in 1798 Scottish-born physician and author ( ) Sir Alexander Crichton described a mental state with all the essential features of the inattentive subtype of ADHD and how it can affect the ability to perform in school. Crichton described a mental restlessnessand the incapacity of attending with a necessary degree of constancy to any one object. When born with a person it becomes evident at a very early period of life, and has a very bad effect, inasmuch as it renders him incapable of attending with constancy to any one object of education. But it seldom is in so great a degree as totally to impede all instruction; and what is very fortunate, it is generally diminished with age. Its a Fact! FACT Boys are diagnosed twice as often as girls. FACT ADHD affects at least 5% to 8% of school age children FACT 3.5 million children meet criteria for ADHD, but only 57% are diagnosed and treated FACT Only 20% of minority children with ADHD are diagnosed References: Froehlich (2007) CDC (2005) CHADD WWK#1 (2004) CHADD Parent to Parent Its a Fact! FACT Children with AD/HD carry symptoms of the disorder into adolescence and adulthood 80% into adolescence 67% into adulthood RESEARCH: PET SCANS: show slower metabolism of glucose in brain MRI research: has found differences in the size of brain structures such as prefrontal cortex, the basal ganglia and the cerebellum fMRI research: shows lower than normal blood flow to the same regions of the brain The Science of AD/HD 1990 Alan Zemetkin, M.D. Landmark study Neurobiological Disorder Strength of Evidence: Strong Genetic Predisposition Strength of Evidence: Strong Other Abnormal Fetal Development Fetal Alcohol Syndrome Injury Probable Causes of AD/HD Impact of ADHD Expect Developmental Delays of Three to Five years (on average) When youre talking to a 10-year-old with ADHD, you may actually be talking to a 6-7 year-old brain! ADHD : AKA EXECUTIVE FUNCTION DISORDER EMOTIONAL DISREGULATION DISORDER Knowing is Easier than Doing! Dr. Ari Tuckman: Executive Functions are our highest level cognitive processes; they help us achieve desired outcomes. Impaired EF of ADHD makes it a disorder of actualizing good intentions. People with ADHD usually know what the right thing to do is, but they cant DO it consistently. Its not knowing what to do its doing what one knows. EXECUTIVE FUNCTIONS Goal Setting: ability to set goals that are realistic and attainable. Initiating: ability to start a boring task Prioritizing: ability to understand the relative importance of all items in a group. Pacing: ability to establish and adjust rate of work to meet goal by specified time. Planning: ability to break down the process of getting to a goal into small, realistic steps. EXECUTIVE FUNCTIONS, cont. Sequencing: understanding the relative order of things, e.g. order of steps to complete task. Organizing: ability to arrange items in an efficient manner according to a system. Shifting: ability to change from one activity to another smoothly. EFD EXECUTIVE FUNCTION DISORDER: When one or more of these functions is not working correctly. Executive Functioning (EF) refers to our ability to organize, prioritize and analyze in order to make reasonable decisions and plans The impaired Executive Functioning skills in individuals with ADHD are related to abnormal dopamine levels in the frontal lobe of the brain. Drawing by Janet W. Smith Revised Children with AD/HD generally suffer from poor Executive Functioning Executive Functioning Dr. Tom Brown uses a metaphor that compares executive functioning of the brain to the function of a conductor of an orchestra Role of Executive Functions as Conductor of the Brain 8C Executive Functions Behavior Thoughts Emotions regulate the volume, tempo, pitch and timing of our behavior, thoughts and emotions CHADD Parent to Parent : 2010 8C Executive Functions are essential learning tools that must function for any student to successfully solve problems read hear think prioritize plan understand remember CHADD Parent to Parent : 2010 CHADD Parent to Parent Behaviors associated with Executive Function Disorder (aka Emotional Dysregulation) The student : Acts before thinking is often extremely impulsive Gets upset, frustrated, and/or annoyed quickly- Loses control easily Needs immediate gratification unable to work for long-term incentives Can be moody and irritable appears to lack concern or sensitivity to others Can be extremely insecure and have low self-esteem Repeats past mistakes does not learn from consequences, so is difficult to discipline effectively Lacks problem-solving skills Has difficulty internalizing rules Has poor awareness of and response to time Has difficulty with transitions and changes in routine or activity Has difficulty organizing self and possessions SELF-REGULATION CHALLENGES FOR THE ADHD STUDENT Self-monitoring: the ability to maintain awareness of oneself, and of what is appropriate in their environment. Inhibiting: the ability to know that one needs to inhibit, and then to inhibit certain behaviors. Executing: completing all the details necessary to finish a task. Using Feedback: using information from those around one and altering behavior accordingly. CHADD Parent to Parent Impulsive Behavior Poor self-control leads to . IMPULSIVE BEHAVIOR READY AIM OOPS ! FIRE Sometimes, we make moral judgments about EF Deficits because.. children (and adults) with EF deficits look like they have made a conscious choice to not try, to not care, to resist help, to give up... to fail. It is extremely easy to blame them for behaviors they cannot address on their own, and of which they are usually unaware. THE GOOD NEWS Executive Function skills continue to develop until the early 30s and, as a person matures, life choices (fields of study, jobs, relationships, etc.) can be made based on genuine interest, which improves EF performance in ADHD brains. AD/HD-The Disability: Who Can Diagnose The Disorder? Psychiatrists Other medical doctors including pediatricians and general practitioners School Psychologist Private Psychologist Social Workers Nurse Practitioners CHADD Parent to Parent Diagnostic criteria of AD/HD A chronic disorder Characterized by a pattern of inattention and/or hyperactivity and/or impulsivity Significantly impaired age-appropriate functioning in at least two areas of life, such as home, social settings, school or work Specified by the DSM-IV-R Diagnostic and Statistical Manual, 4 th Edition American Psychiatric Association CHADD Parent to Parent AD/HD Types AD/HD Diagnostic Subtypes: Primarily Inattentive Type Primarily Hyperactive/Impulsive Type Combined Type AD/HD- Co- Existing Conditions Conduct Disorder 35% Depression 35% Tics/Tourettes 7% Bipolar 20% Oppositional Defiant Disorder 40% Learning Disabilities 50% Anxiety 35% Co-existing CHADD Parent to Parent Predominately Inattentive Type AD/HD- I At least six of nine characteristics are required for diagnosis: Often avoids, dislikes or is reluctant to engage in tasks requiring sustained mental effort (school or homework). Often loses things necessary for tasks or activities (toys, assignments, tools). Often easily distracted by extraneous stimuli. Often forgetful in daily activities. CHADD Parent to Parent Predominately Inattentive Type AD/HD-I At least six of nine characteristics are required for diagnosis: Often fails to give close attention to details or makes careless mistakes in schoolwork, the work environment or other activities. Often has difficulty sustaining attention in tasks or play activities. Often does not seem to listen when spoken to directly. Often does not follow through on instructions and fails to finish schoolwork or other tasks. Often has difficulty organizing tasks and activities. (contd.) CHADD Parent to Parent Predominately Hyperactive/Impulsive Type At least six of nine characteristics are required for diagnosis: Hyperactivity Often fidgets with hands or feet or squirms in seat Often leaves seat in classroom or other situations in which remaining seated is the expectation Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents and adults, it may be limited to subjective feelings of restlessness) Often has difficulty playing or engaging in leisure activities quietly Often on the go or acts as if driven by a motor CHADD Parent to Parent Predominately Hyperactive/Impulsive Type Impulsivity Often blurts out answers before questions have been completed Often has difficulty waiting turn Often interrupts or intrudes on others AD/HD- Multimodal Treatment Appropriate educational program with interventions and accommodations, as needed, with knowledgeable teachers. Parent training in diagnosis, treatment, and specific behavior management techniques Individual family training when needed Medication when needed AD/HD-Multimodal Treatment: Academic Interventions Intervention Planning (Documentation) Section 504 of the Rehabilitation Act of 1973(Section 504) Individual Education Plan (IEP) ADHD Coaching/ Tutoring Social Skills Training AD/HD-The Disability: Without Identification and Proper Treatment School failure Depression Conduct disorder Failed Relationships Substance abuse CHADD Parent to Parent AD/HD Left Untreated Can Lead to Academic and Social Failure and Increased Loss of Self Esteem Behavior Problems and Parenting Issues This can lead to: MAJOR Life Problems and Destructive Paths ADD CHADD Parent to Parent Disability Perspective Adopting a disability perspective provides the foundation for helping a child with AD/HD. A disability perspective shapes a parents responses to the childs symptoms of AD/HD. A disability perspective encourages the parent to be supportive, positive and sensitive to their child with AD/HD. Look, I let the sunlight in. CHADD Parent to Parent Principles of a Disability Perspective Children with AD/HD Have a legitimate medical condition that undermines the ability to regulate their behavior. Have the same need/desire as other children to gain acceptance from others. Can improve their conduct with the assistance of effective strategies/interventions. Should be expected to make gradual rather than rapid behavior progress. Will respond more favorably to supportive/positive discipline strategies than to rejecting/punitive discipline strategies. The solution is to educate ourselves so that we replace blame with support, impatience with understanding, and punishment with scaffolding : Strategies and Skills that will help all our ADHD students succeed. CHADD Parent to Parent ADHD is a Neurobiological Disorder Probable causes of ADHD Differences in brain structure and function Problems with communication between neurons More Science The impaired Executive Functioning skills in individuals with ADHD are related to abnormal dopamine levels in the frontal lobe of the brain. Stimulant medication increases dopamine levels in the pre-frontal cortex. Role of the Conductor of an Orchestra 8C CHADD Parent to Parent : 2010