Craig Wiener Ed.D .

1. Craig Wiener Ed.D. Assistant Professor: University of Massachusetts Medical School, Department of Family Medicine and Community Health Clinical Director: Family Health Center of Worcester Private Practice: 48 Cedar St. Worcester, Ma. 01609 Phone:508 756-4825 Website: www.craigwiener.com

2. This presentation is based on two recently published books by Craig Wiener

3. And a third book for parentsParenting Your Child with ADHD: A No Nonsense Guide For Nurturing Self-Reliance and Cooperation New Harbinger Publications

4. Current view Biogenetic problem that causes Hyperactivity/impulsivity & distractibility 9% of children U.S. Department of Health & Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics

5. Inferior biological/mental inhibitory mechanism Less able To stop, look, listen, and think before taking action (Douglas, 1972). They will not manage their futures effectively

6. Unless people can Inhibit immediate reactions engage “executive functioning” And concentrate long enough To generate effective longer-term responses (Fuster, 1997; Barkley, 2006).

7. They will be • Enticed by immediate gratifications

8. Biological causality for ADHD is based on three pillars (research findings)(Pliszka, Mc-Cracken, and Maas, 1996).

9. It runs in families

10. Identical twins are almost always concordantIf one shows ADHD than the other will too

11. People with ADHD more often have certain genes • 7-repeat allele (DRD4) • Increases chance of diagnosis by 50% • LaHose et al., 1996; Barkley, 2006

12. Different Brain • Structure • smaller and less differentiated • Responding • Diminished arousal and activation • And Chemistry • Less availability of neurotransmitters • dopamine and nor epinephrine Barkley, 2006; Brown, 2010

13. Medications work instantaneously • Since changing biology improves ADHD • the etiology of the behaviors must be biological

14. But these pillars are fragile

15. Genetic research does not establish a biological etiology • There are many people diagnosed with ADHD without the genetic variations • There are many people notdiagnosed with ADHDwith the variations Shaw et al., 2007; Swanson et al., 2000; Chang et al., 1996

16. In comparison to other medical problems • No biological markers (or dysfunctions of any kind) that can be used to make the diagnosis • Too many false positives and false negatives

17. A 50% increased risk from having the genetic constitution • Only means that: A person’s chance of being diagnosed rises from 9% to 13.5% Hardly a reason to panic

18. With ADHD • Genetics is not destiny or fate • Nurturing can be influential

19. A psychological perspective anticipates that family members will show similar behaviors Related people have similar bodies and environments So their probabilities for learning are similar Extreme with identical twins A heightened confounding of genetics and learning

20. It will not matter if you are the birth parent or adopted parent • Biology changes the probability of what is learned- a temporal (not causal) origin • Height  Basketball player • Physically Attractive  Popular • Physically Awkward  Low Social Status, Sports Avoidance

21. Parents are not blamed

22. Children with particular kinds of problems are more likely to develop ADHD Behavior Developmental Delay Coordination Disorder Specific speech or learning problems Health complications Short attention span with objects High activity levels Negative infant temperament (Barkley, 2006)

23. While there are • Many people with ADHD • who do not have these kinds of early occurring problems • ADHD is more likely to develop under these conditions of adversity

24. Functional Delay in ADHD Functional Delay Functional Delay ADHD Traditional View New Model ADHD

25. But Remember • You can influence heritability quotients by changing the typical course of development

26. Yes, people with ADHD tend to have different brain biology • But the way you live and learn can also affect the biology of your brain • Dopamine levels can increase with positive experiences Schultz, Dayan, & Montague, 1997; Wickelgren, 1997

27. Differences in brain response may relate to learning • MRI data shows • Brain blood flow varies in relation to observing someone with the same or different political affiliation • Patterns of brain activation and arousal can be a function of what you are doing and what you have learned Elias, 2004

28. With musicians The planumtemporale • becomes larger • more asymmetrical As a consequence of playing a musical instrument Gaser and Schlaug, 2003

29. Brain differences can show • Relationships between • patterns of living and biological developments • The consequence of the co-occurrence of biology and environment

30. So it is not surprising that • ADHD responding alters biological development and impairs skills and achievement (including performance on psychological tests) • As the saying goes: If you don’t use it, you lose it.

31. IN REVIEW: Biological Causality is not established by the first two Pillars • We may have biology or impairment that comes before ADHD • But that does not demonstrate incipient ADHD • It only demonstrates an increased probability that ADHD behaviors will evolve. • Many different outcomes can occur as development unfolds. • We may have biology or impairment that occurs with or after ADHD • But co-occurrence does not show causality • Biology and skill acquisition are influenced by the way a person lives in the world.

32. YES-medicine reduces ADHD Behavior • But it does not identify the cause of ADHD • Alcohol helps with sociability, but this does not tell us why the person was not social

33. ADHD medications can be a potent and practical solution Due to urgency and resources of participants But they do not tell us about the cause of ADHD

34. There is yet another looming concern with traditional view: • Why would a biological disability respond so remarkably to • Bribery • Personal interest • Instruction source Child initiated expected by others • How can you exceed your disability? • Many parents ask, “Why can my child function so well when she is doing what she wants to do?”

35. Psychology must be involved if the problem relates to personal interest

36. History of conditioning • Can account for the frequency rates of ADHD • Situational patterns • indicate that the behaviors are reinforced

37. by Brian NelsonSun Spott Studios Hyperactivity occurs when parents are on the phone Cartoons

38. But not if bedtime is extended while the parent talks

39. Distractibility prevails when writing a “thank you” note

40. But not when writing a Christmas list

41. Blurting occurs when vying for attention or provoking

42. But not when there could be incrimination

43. Unpleasant appointments are often missed

44. But it’s first in line for scheduled trips to the movies

45. The daily planner Is cast aside

46. While plans on “Facebook” are being made

47. Personal belongings are scattered about

48. While battle scenes are meticulously arranged

49. Chores are left undone

50. But the house sparkles when “buttering up” the parent