Attention Deficit Disorder

1. Attention Deficit Disorder ESE 380 February 26, 2009

2. Classification • Other Health Impairment • 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 hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, and sickle cell anemia; and adversely affects a child’s educational performance. (34 Code of Federal Regulations § 300.7[c][9])

3. Eligibility • A student who qualifies as having attention deficit disorder, and who requires an individualized education plan must: • Meet the criteria under the general category of Other Health Impairment, and • Have a medical diagnosis of attention deficit disorder or attention deficit hyperactivity disorder • Medical doctors • Psychologists • psychiatrists

4. Three Types of Attention Deficit Disorder • Inattentive • Impulsive/hyperactive • Combined

5. Inattentive Type • six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:  • often fails to give close attention to details or makes careless mistakes in schoolwork, work, 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, chores, or duties in the workplace (not due to oppositional behavior or failure • to understand instructions) • often has difficulty organizing tasks and activities • often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework) • often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools) • is often easily distracted by extraneous stimuli • is often forgetful in daily activities    

6. Impulsive/Hyperactive Type • six (or more) of the following symptoms of hyperactivity and/or impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level: Hyperactivity  • often fidgets with hands or feet or squirms in seat • often leaves seat in classroom or in other situations in which remaining seated is expected • often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness) • often has difficulty playing or engaging in leisure activities quietly • is often "on the go" or often acts as if "driven by a motor" • often talks excessively  

7. Impulsive/Hyperactive Type • six (or more) of the following symptoms of hyperactivity and/or impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level: Impulsivity • often blurts out answers before questions have been completed • often has difficulty awaiting turn • often interrupts or intrudes on others (e.g., butts into conversations or games)    

8. Additional Criteria • Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.   • Some impairment from the symptoms is present in two or more settings (e.g., at school [or work] and at home).   • There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.  

9. True or False? • People eventually outgrow AD/HD. • AD/HD stems from a lack of will or any effort at self-control. • AD/HD is caused by parents who don’t discipline their children. • AD/HD results from children watching too much television or playing too many video games. • Dietary issues such as too much sugar cause AD/HD. • AD/HD results from living in a fast-paced,

10. Executive Functioning • Non-verbal working memory • the ability to retrieve auditory, visual, and other sensory images of the past • Internalization of speech • planning what to do and say, and recognizing when it is appropriate to speak thoughts • Self-regulation of affect, motivation, and arousal • less objective and more emotional in responding to events, have difficulty understanding the effect of behavior on others, and often cannot generate the energy and enthusiasm to carry out behavior • Reconstitution • the skill of analyzing and synthesizing behaviors

11. What’s the Issue? • Carl is in fifth grade, and has been sent to the office on multiple occasions for disrupting class with his constant interrupting. Each time, Carl expresses remorse for his behavior, and says that he won’t do it again. • What executive functioning is Carl having trouble with?

12. What’s the Issue? • Paula is in your sixth grade class. You have assigned ten spelling words for the week, and Paula missed six of them on the pre-test. You give her some exercises and activities to do to help her practice them for the test on Friday. • When she is beginning to do her exercises on Thursday night, her friend calls to tell her that the long-anticipated season debut of Paula’s favorite TV show is starting. Paula drops her spelling work and watches the show, then goes to bed. • What executive functioning is paula struggling with?

13. Another Look at ADD • Dr. Daniel Amen • Dr. Russell Barkley • Use of brain imaging

14. The Research • Joel Lubar, University of Tennessee • Children and adolescents under concentration tasks show increased rate of “slow brain wave” activity. • Reduced amount of dopamine in the frontal lobes • The justification for stimulant medication

15. Intervention Strategies Multi-modal Approach • Motivation • Medication • Classroom management (FBA/BIP) • Peer and adult mentoring/coaching • Counseling • Extra-curricular involvement

16. The “No Brainers” • Keys to Motivating Students   • Relevance  • Novelty  • Variety  • Choices  • Activity  • Challenge  • Feedback 

17. Stimulant Medications • Stimulants • Medications Used with Attention Deficit and Attention Deficit Hyperactivity Disorder  • Stimulants • Ritalin   • Dexadrine    • Cylert    • Adderall • Concerta  • Implications • ·       increase attentiveness • ·       reduce distractibility • ·       enhance concentration • ·       decrease motor restlessness  

18. Anti-Depressant Medications • Norpramin          \ • Tofranil               • Wellbutrin  • Implications • ·       Increase the ability to direct and maintain attention • ·       Reduce distractibility • ·       Produce a calming effect • ·       decrease impulsive behavior • ·       stop temper tantrums • ·       regulate frequent mood shifts • ·       increase reading and learning abilities.  

19. SPECT Imaging • Dr. Daniel Amen • Seven Types of ADD • Combined Type • Inattentive • Over-focused • Temporal Lobe • Limbic • Ring of fire • Trauma-Induced • www.brainplace.com

20. Combined Type • 1. AD/HD, combined type with both symptoms of inattention and hyperactivity-impulsivity. SPECT Brain imaging typically shows decreased activity in the basal • ganglia and prefrontal cortex during a concentration task. This subtype of ADD typically responds best to psychostimulant medication.

21. Characteristics of Combined Type • inattentive, • distractible, • disorganized, • hyperactive, • restless and impulsive  • Very similar to combined type from DSM  

22. Characteristics of Inattentive Type • Sluggish • Slow • Preoccupied • Uninterested • Poorly motivated or simply bored • Difficulty in listening and registering the content of conversation

23. Characteristics of Over-focused Type • Have trouble shifting attention from one subject to another • Oppositional and argumentative • Worry excessively or senselessly • Strong tendency to get locked into negative thoughts • May hold grudges for a long time • Have difficulty in viewing other options; therefore may get locked into one course of action

24. Characteristics of Temporal Lobe type • inattention and impulsivity along with…  • Periods of unprovoked outbursts of anger • Tendency to become increasingly irritable until They explode and then withdraw • Periods of "spaciness" and mental confusion, • May have periods of panic or unexplained fear • May be overly sensitive and somewhat paranoid • Tend to misinterpret innocent comments and remarks of others   

25. Characteristics of Limbic Type • Inattention, along with…  • tendency for moodiness, • negativity, • isolation and • depression  • tendency for sleep problems (sleeping too little or too much) • feelings of guilt, • hopelessness • personal worthlessness  • likely to be mistaken as suffering from chronic depression  

26. Ring of Fire Images • many of the children and teenagers who present with symptoms of ADD have the "ring of fire" pattern on SPECT. They often do not respond to psychostimulant medication and in many cases are made worse by them. They tend to improve with either anticonvulsant medications or the new, novel antipsychotic medications. We think it may represent an early bipolar pattern.

27. Characteristics of Ring of Fire Type • severe oppositional behavior • distractibility • irritability • temper problems • mood swings. • oppositional or aggressive • often very hyper or hyperverbal • easily distracted or has too many thoughts moodiness • cyclic behavioral changes hypersensitivity to light, sound, taste or touch.