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ADHD Affecting us from Dawn to Dusk What can counselors do

ADHD

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ADHD Affecting us from Dawn to Dusk What can counselors do

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    1. ADHD – Affecting us from Dawn to Dusk What can counselors do?

    2. ADHD – Affecting us from Dawn to Dusk What can counselors do?

    3. ADHD – Affecting us from Dawn to Dusk What can counselors do?

    4. ADHD – Affecting us from Dawn to Dusk What can counselors do?

    5. ADHD – Affecting us from Dawn to Dusk What can counselors do?

    6. ADHD – Affecting us from Dawn to Dusk What now?

    7. ADHD – Affecting us from Dawn to Dusk What now?

    8. Introduction Charles Pemberton – LPCC, NBCC Past President KCA Ed.D. in Educational Counseling 20+ years in Counseling and Mental Health Presented in England, South Africa, Central America, and US. Adjunct Professor – Graduate University of Louisville Undergraduate –KCTCS Private Practice – 80% children and families ADHD Depression Aggression Anxiety

    9. Today’s Schedule Diagnosis and Identification Child and Adult Discussions about “it” Assessments Treatment Plans Medication Academic Other Questions

    10. What you won’t get today! Complete picture of treatment options A plan that will work everywhere with everyone A cure

    11. Quick Quiz What are the biggest issues for patients with ADHD? What are the biggest issues for parents of children with ADHD? What are the biggest issues for teachers/counselors of patients with ADHD?

    12. Family Relationships 22.7% compared to 12.6% divorce 75% compared to 43% reported problems with child

    13. ADHD Effects Academic Work/Career Social Friends Spouse Leisure 13

    14. Language of ADHD Causes Features Criteria Prevalence Differential vs. Co morbid

    15. Causes of ADHD Biological Disorder Neurological – dopamine/norepinephrine Genetic Toxins Head injuries Immunizations Modeling No evidence: Sugar Food additives Allergies

    16. Major Features

    17. Major Features Often will not complete tasks Easily distracted by minor stimuli Work often messy and completed w/o thought Forgetful in day-to-day activities Impulsive (interrupting others, cannot wait turn, etc.) Fidgetiness Excessive talking

    18. Major Features -Adults concentration problems forgetfulness and poor short-term memory lack of organization problems with creating and maintaining routines lack of self-discipline depression

    19. Major Features -Adults low self-esteem restless mind restlessness poor time management impatience and frustration poor social skills and making inappropriate remarks feelings of underachievement.

    20. Current Diagnostic Criteria B. symptom onset PRIOR to age 7 years C. impairment present in two or more environments D. clear clinically significant impairment in functioning E. cannot be accounted for by other mental disorder

    21. DSM5 - Proposed B. several noticeable symptoms present by age 12 C. symptoms apparent in two or more environments D. clearly interfere with or reduce quality of… E. Pervasive Development D/O dropped

    22. New Criteria? Less on emphasis on Behavior More on brain coping skills: Memory Focus Ability to regulate emotions Motivational issues

    23. Prevalence What is the prevalence of ADHD? Estimated at 3-7% of school age children More boys or girls? More common in males than females When Diagnosed? Often diagnosed during elementary school years.

    24. Must distinguish from age-appropriate behaviors Mental Retardation or Learning Disability Oppositional behavior (ODD, Conduct D/O) Stereotypic Movement D/O Behavior due to medications Mood or Anxiety D/O Differential Diagnosis

    25. Oppositional Defiance Disorder Conduct disorder Mood Disorder Anxiety Disorder Learning Disorder Tourettes Hx abuse or neglect, multiple foster homes, lead poisoning, Mental Retardation Co morbid

    26. Types according to Dr. Amen Type 1: Classic ADD Restlessness, hyperactivity, constant motion, troubles sitting still, talkative, impulsive behavior, lack of thinking ahead . Type 2: Inattentive ADD Short attention span (especially about routine matters), distractibility, disorganization, procrastination, poor follow-through/task completion. 26

    27. Types cont’ Type 3: Overfocused ADD Worrying, holds grudges, stuck on thoughts, stuck on behaviors, addictive behaviors, oppositional/argumentative. Type 4: Limbic ADD Sad, moody, irritable, negative thoughts, low motivation, sleep/appetite problems, social isolation, finds little pleasure. 27 This is the kind of child who worries about things turning out exactly as he anticipates or wishes, gets extremely upset when his wishes are not satisfied, and then may argue intensely and without end to "get his way". He may engage in ritualistic behaviors that must be followed, or else intense upset occurs. This child lacks flexibility in his thinking, has great difficulty shifting his attention away from whatever is his current focus, and is often unable to see options, to go with the flow, or to cooperate with others in situations. There are often other family members with similar characteristics of being overfocused. This can also be thought of as Obsessive-Compulsive ADD. This is the kind of child who worries about things turning out exactly as he anticipates or wishes, gets extremely upset when his wishes are not satisfied, and then may argue intensely and without end to "get his way". He may engage in ritualistic behaviors that must be followed, or else intense upset occurs. This child lacks flexibility in his thinking, has great difficulty shifting his attention away from whatever is his current focus, and is often unable to see options, to go with the flow, or to cooperate with others in situations. There are often other family members with similar characteristics of being overfocused. This can also be thought of as Obsessive-Compulsive ADD.

    28. Types cont’ Type 5: Temporal Lobe ADD Inattentive/spacey/confused, emotional instability, memory problems, periodic intense anxiety, periodic outbursts of aggressive behavior seemingly triggered by small events or intense angry criticisms directed at himself for failures and frustrations, overly sensitive to criticism and slights by others, frequent headaches and/or stomachaches, learning difficulties, and serious misperceptions/distortions of people and situations. This kind of child struggles greatly to read social cues, understand facial expressions, and appreciate tone of voice. He may not "get the message" in social situations unless it is spelled out clearly, in bold letters, repeatedly, and then may make the same mistake the next time in the same or similar situation. His misperceptions may be very dramatic, such that typical teasing/joking/"messing with each other" that kids engage in may be felt to be severe personal attacks, which prompt intense retaliations. He may also not appreciate the impact of his own behavior, failing to see how he may be provoking/irritating to others. Learning difficulties may involve auditory and/or visual processing deficits - the kind of learning disabilities that can be assessed with standard testing instruments. This kind of ADD may be thought of as Explosive ADD.This kind of child struggles greatly to read social cues, understand facial expressions, and appreciate tone of voice. He may not "get the message" in social situations unless it is spelled out clearly, in bold letters, repeatedly, and then may make the same mistake the next time in the same or similar situation. His misperceptions may be very dramatic, such that typical teasing/joking/"messing with each other" that kids engage in may be felt to be severe personal attacks, which prompt intense retaliations. He may also not appreciate the impact of his own behavior, failing to see how he may be provoking/irritating to others. Learning difficulties may involve auditory and/or visual processing deficits - the kind of learning disabilities that can be assessed with standard testing instruments. This kind of ADD may be thought of as Explosive ADD.

    29. Types cont’ Type 6: Ring of Fire ADD A ring of overactivity in the brain scan image which surrounds most of the brain is the source of the name for this type of ADD. too many thoughts, very hyper behavior, very hyper verbal expressiveness, a hypersensitivity to light, sound, taste, or touch. 29 A ring of overactivity in the brain scan image which surrounds most of the brain is the source of the name for this type of ADD. It is characterized by too many thoughts, very hyper behavior, very hyper verbal expressiveness, a hypersensitivity to light, sound, taste, or touch. This child is often easily distracted, aggressive, oppositional, and moody. His thoughts may "race" with overly grand ideas and expectations. The changes in behavior observed in this child may occur on a cyclical basis. This is ADD with Bipolar features, often a manic quality that is difficult to manage. A ring of overactivity in the brain scan image which surrounds most of the brain is the source of the name for this type of ADD. It is characterized by too many thoughts, very hyper behavior, very hyper verbal expressiveness, a hypersensitivity to light, sound, taste, or touch. This child is often easily distracted, aggressive, oppositional, and moody. His thoughts may "race" with overly grand ideas and expectations. The changes in behavior observed in this child may occur on a cyclical basis. This is ADD with Bipolar features, often a manic quality that is difficult to manage.

    30. Ring of Fire 30 A ring of overactivity in the brain scan image which surrounds most of the brain is the source of the name for this type of ADD. It is characterized by too many thoughts, very hyper behavior, very hyper verbal expressiveness, a hypersensitivity to light, sound, taste, or touch. This child is often easily distracted, aggressive, oppositional, and moody. His thoughts may "race" with overly grand ideas and expectations. The changes in behavior observed in this child may occur on a cyclical basis. This is ADD with Bipolar features, often a manic quality that is difficult to manage. A ring of overactivity in the brain scan image which surrounds most of the brain is the source of the name for this type of ADD. It is characterized by too many thoughts, very hyper behavior, very hyper verbal expressiveness, a hypersensitivity to light, sound, taste, or touch. This child is often easily distracted, aggressive, oppositional, and moody. His thoughts may "race" with overly grand ideas and expectations. The changes in behavior observed in this child may occur on a cyclical basis. This is ADD with Bipolar features, often a manic quality that is difficult to manage.

    31. Hundred Acre Wood 1 = 2 = 3 = 4 = 5 = 31 A ring of overactivity in the brain scan image which surrounds most of the brain is the source of the name for this type of ADD. It is characterized by too many thoughts, very hyper behavior, very hyper verbal expressiveness, a hypersensitivity to light, sound, taste, or touch. This child is often easily distracted, aggressive, oppositional, and moody. His thoughts may "race" with overly grand ideas and expectations. The changes in behavior observed in this child may occur on a cyclical basis. This is ADD with Bipolar features, often a manic quality that is difficult to manage. A ring of overactivity in the brain scan image which surrounds most of the brain is the source of the name for this type of ADD. It is characterized by too many thoughts, very hyper behavior, very hyper verbal expressiveness, a hypersensitivity to light, sound, taste, or touch. This child is often easily distracted, aggressive, oppositional, and moody. His thoughts may "race" with overly grand ideas and expectations. The changes in behavior observed in this child may occur on a cyclical basis. This is ADD with Bipolar features, often a manic quality that is difficult to manage.

    32. Hundred Acre Wood 1 = Typical ADD = 2 = 3 = 4 = 5 = 32 A ring of overactivity in the brain scan image which surrounds most of the brain is the source of the name for this type of ADD. It is characterized by too many thoughts, very hyper behavior, very hyper verbal expressiveness, a hypersensitivity to light, sound, taste, or touch. This child is often easily distracted, aggressive, oppositional, and moody. His thoughts may "race" with overly grand ideas and expectations. The changes in behavior observed in this child may occur on a cyclical basis. This is ADD with Bipolar features, often a manic quality that is difficult to manage. A ring of overactivity in the brain scan image which surrounds most of the brain is the source of the name for this type of ADD. It is characterized by too many thoughts, very hyper behavior, very hyper verbal expressiveness, a hypersensitivity to light, sound, taste, or touch. This child is often easily distracted, aggressive, oppositional, and moody. His thoughts may "race" with overly grand ideas and expectations. The changes in behavior observed in this child may occur on a cyclical basis. This is ADD with Bipolar features, often a manic quality that is difficult to manage.

    33. Hundred Acre Wood 1 = Typical ADD = Winnie 2 = 3 = 4 = 5 = 33 A ring of overactivity in the brain scan image which surrounds most of the brain is the source of the name for this type of ADD. It is characterized by too many thoughts, very hyper behavior, very hyper verbal expressiveness, a hypersensitivity to light, sound, taste, or touch. This child is often easily distracted, aggressive, oppositional, and moody. His thoughts may "race" with overly grand ideas and expectations. The changes in behavior observed in this child may occur on a cyclical basis. This is ADD with Bipolar features, often a manic quality that is difficult to manage. A ring of overactivity in the brain scan image which surrounds most of the brain is the source of the name for this type of ADD. It is characterized by too many thoughts, very hyper behavior, very hyper verbal expressiveness, a hypersensitivity to light, sound, taste, or touch. This child is often easily distracted, aggressive, oppositional, and moody. His thoughts may "race" with overly grand ideas and expectations. The changes in behavior observed in this child may occur on a cyclical basis. This is ADD with Bipolar features, often a manic quality that is difficult to manage.

    34. Hundred Acre Wood 1 = Typical ADD = Winnie 2 = Typical Hyperactive = 3 = 4 = 5 = 34 A ring of overactivity in the brain scan image which surrounds most of the brain is the source of the name for this type of ADD. It is characterized by too many thoughts, very hyper behavior, very hyper verbal expressiveness, a hypersensitivity to light, sound, taste, or touch. This child is often easily distracted, aggressive, oppositional, and moody. His thoughts may "race" with overly grand ideas and expectations. The changes in behavior observed in this child may occur on a cyclical basis. This is ADD with Bipolar features, often a manic quality that is difficult to manage. A ring of overactivity in the brain scan image which surrounds most of the brain is the source of the name for this type of ADD. It is characterized by too many thoughts, very hyper behavior, very hyper verbal expressiveness, a hypersensitivity to light, sound, taste, or touch. This child is often easily distracted, aggressive, oppositional, and moody. His thoughts may "race" with overly grand ideas and expectations. The changes in behavior observed in this child may occur on a cyclical basis. This is ADD with Bipolar features, often a manic quality that is difficult to manage.

    35. Hundred Acre Wood 1 = Typical ADD = Winnie 2 = Typical Hyperactive = Tigger 3 = 4 = 5 = 35 A ring of overactivity in the brain scan image which surrounds most of the brain is the source of the name for this type of ADD. It is characterized by too many thoughts, very hyper behavior, very hyper verbal expressiveness, a hypersensitivity to light, sound, taste, or touch. This child is often easily distracted, aggressive, oppositional, and moody. His thoughts may "race" with overly grand ideas and expectations. The changes in behavior observed in this child may occur on a cyclical basis. This is ADD with Bipolar features, often a manic quality that is difficult to manage. A ring of overactivity in the brain scan image which surrounds most of the brain is the source of the name for this type of ADD. It is characterized by too many thoughts, very hyper behavior, very hyper verbal expressiveness, a hypersensitivity to light, sound, taste, or touch. This child is often easily distracted, aggressive, oppositional, and moody. His thoughts may "race" with overly grand ideas and expectations. The changes in behavior observed in this child may occur on a cyclical basis. This is ADD with Bipolar features, often a manic quality that is difficult to manage.

    36. Hundred Acre Wood 1 = Typical ADD = Winnie 2 = Typical Hyperactive = Tigger 3 = over focused = 4 = 5 = 36 A ring of overactivity in the brain scan image which surrounds most of the brain is the source of the name for this type of ADD. It is characterized by too many thoughts, very hyper behavior, very hyper verbal expressiveness, a hypersensitivity to light, sound, taste, or touch. This child is often easily distracted, aggressive, oppositional, and moody. His thoughts may "race" with overly grand ideas and expectations. The changes in behavior observed in this child may occur on a cyclical basis. This is ADD with Bipolar features, often a manic quality that is difficult to manage. A ring of overactivity in the brain scan image which surrounds most of the brain is the source of the name for this type of ADD. It is characterized by too many thoughts, very hyper behavior, very hyper verbal expressiveness, a hypersensitivity to light, sound, taste, or touch. This child is often easily distracted, aggressive, oppositional, and moody. His thoughts may "race" with overly grand ideas and expectations. The changes in behavior observed in this child may occur on a cyclical basis. This is ADD with Bipolar features, often a manic quality that is difficult to manage.

    37. Hundred Acre Wood 1 = Typical ADD = Winnie 2 = Typical Hyperactive = Tigger 3 = over focused = Rabbit 4 = 5 = 37 A ring of overactivity in the brain scan image which surrounds most of the brain is the source of the name for this type of ADD. It is characterized by too many thoughts, very hyper behavior, very hyper verbal expressiveness, a hypersensitivity to light, sound, taste, or touch. This child is often easily distracted, aggressive, oppositional, and moody. His thoughts may "race" with overly grand ideas and expectations. The changes in behavior observed in this child may occur on a cyclical basis. This is ADD with Bipolar features, often a manic quality that is difficult to manage. A ring of overactivity in the brain scan image which surrounds most of the brain is the source of the name for this type of ADD. It is characterized by too many thoughts, very hyper behavior, very hyper verbal expressiveness, a hypersensitivity to light, sound, taste, or touch. This child is often easily distracted, aggressive, oppositional, and moody. His thoughts may "race" with overly grand ideas and expectations. The changes in behavior observed in this child may occur on a cyclical basis. This is ADD with Bipolar features, often a manic quality that is difficult to manage.

    38. Hundred Acre Wood 1 = Typical ADD = Winnie 2 = Typical Hyperactive = Tigger 3 = over focused = Rabbit 4 = sad = 5 = 38 A ring of overactivity in the brain scan image which surrounds most of the brain is the source of the name for this type of ADD. It is characterized by too many thoughts, very hyper behavior, very hyper verbal expressiveness, a hypersensitivity to light, sound, taste, or touch. This child is often easily distracted, aggressive, oppositional, and moody. His thoughts may "race" with overly grand ideas and expectations. The changes in behavior observed in this child may occur on a cyclical basis. This is ADD with Bipolar features, often a manic quality that is difficult to manage. A ring of overactivity in the brain scan image which surrounds most of the brain is the source of the name for this type of ADD. It is characterized by too many thoughts, very hyper behavior, very hyper verbal expressiveness, a hypersensitivity to light, sound, taste, or touch. This child is often easily distracted, aggressive, oppositional, and moody. His thoughts may "race" with overly grand ideas and expectations. The changes in behavior observed in this child may occur on a cyclical basis. This is ADD with Bipolar features, often a manic quality that is difficult to manage.

    39. Hundred Acre Wood 1 = Typical ADD = Winnie 2 = Typical Hyperactive = Tigger 3 = over focused = Rabbit 4 = sad = Eeyore 5 = 39 A ring of overactivity in the brain scan image which surrounds most of the brain is the source of the name for this type of ADD. It is characterized by too many thoughts, very hyper behavior, very hyper verbal expressiveness, a hypersensitivity to light, sound, taste, or touch. This child is often easily distracted, aggressive, oppositional, and moody. His thoughts may "race" with overly grand ideas and expectations. The changes in behavior observed in this child may occur on a cyclical basis. This is ADD with Bipolar features, often a manic quality that is difficult to manage. A ring of overactivity in the brain scan image which surrounds most of the brain is the source of the name for this type of ADD. It is characterized by too many thoughts, very hyper behavior, very hyper verbal expressiveness, a hypersensitivity to light, sound, taste, or touch. This child is often easily distracted, aggressive, oppositional, and moody. His thoughts may "race" with overly grand ideas and expectations. The changes in behavior observed in this child may occur on a cyclical basis. This is ADD with Bipolar features, often a manic quality that is difficult to manage.

    40. Hundred Acre Wood 1 = Typical ADD = Winnie 2 = Typical Hyperactive = Tigger 3 = over focused = Rabbit 4 = sad = Eeyore 5 = worried = 40 A ring of overactivity in the brain scan image which surrounds most of the brain is the source of the name for this type of ADD. It is characterized by too many thoughts, very hyper behavior, very hyper verbal expressiveness, a hypersensitivity to light, sound, taste, or touch. This child is often easily distracted, aggressive, oppositional, and moody. His thoughts may "race" with overly grand ideas and expectations. The changes in behavior observed in this child may occur on a cyclical basis. This is ADD with Bipolar features, often a manic quality that is difficult to manage. A ring of overactivity in the brain scan image which surrounds most of the brain is the source of the name for this type of ADD. It is characterized by too many thoughts, very hyper behavior, very hyper verbal expressiveness, a hypersensitivity to light, sound, taste, or touch. This child is often easily distracted, aggressive, oppositional, and moody. His thoughts may "race" with overly grand ideas and expectations. The changes in behavior observed in this child may occur on a cyclical basis. This is ADD with Bipolar features, often a manic quality that is difficult to manage.

    41. Hundred Acre Wood 1 = Typical ADD = Winnie 2 = Typical Hyperactive = Tigger 3 = over focused = Rabbit 4 = sad = Eeyore 5 = worried = Piglet 41 A ring of overactivity in the brain scan image which surrounds most of the brain is the source of the name for this type of ADD. It is characterized by too many thoughts, very hyper behavior, very hyper verbal expressiveness, a hypersensitivity to light, sound, taste, or touch. This child is often easily distracted, aggressive, oppositional, and moody. His thoughts may "race" with overly grand ideas and expectations. The changes in behavior observed in this child may occur on a cyclical basis. This is ADD with Bipolar features, often a manic quality that is difficult to manage. A ring of overactivity in the brain scan image which surrounds most of the brain is the source of the name for this type of ADD. It is characterized by too many thoughts, very hyper behavior, very hyper verbal expressiveness, a hypersensitivity to light, sound, taste, or touch. This child is often easily distracted, aggressive, oppositional, and moody. His thoughts may "race" with overly grand ideas and expectations. The changes in behavior observed in this child may occur on a cyclical basis. This is ADD with Bipolar features, often a manic quality that is difficult to manage.

    42. Assessment Tools No test available Examples of Tests Dx by: Observation Rating Scales Vanderbilt Conner’s SNAP Conner’s Continuous Performance 42

    43. Assessment – Am. Acad. Of Pediatrics Evaluate any child 6 to 12 years of age who shows signs of school difficulties, academic underachievement, troublesome relationships with teachers, family members, peers, and other behavioral problems. Use DSM-IV criteria; these require that ADHD symptoms be present in 2 or more of a child's settings, and that the symptoms adversely affect the child's academic or social functioning for at least 6 months. Requires information from parents or caregivers and a teacher or other school professional regarding core symptoms of ADHD in various settings, age of onset, duration of symptoms, and degree of impairment. Assessment for co-existing conditions: learning and language problems, aggression, disruptive behavior, depression or anxiety.

    44. Some Great Things About Having ADHD: Can meet someone, fall deeply in love, marry, fight, hate, and divorce, all in about 35 minutes or less. Can see all of your worldly possessions at one time...because they are all over the floor Make far reaching analogies that no one else understands. Write them off as "Deep Thoughts“ Qualify for bulk rate mail on tax returns because you have at least 24 W-2's attached. Honestly believes that anything is possible Willing to "step out on faith" A greater tolerance for "Chaos”

    45. Ways to talk about it Use a script Practice Timing Best time Gauge conversation Right amount of information Remember Legal issues 45

    46. Treatment Plans Medication Education General Awareness Skill Building 46

    47. Treatment Plans Medication Alternatives Fish Oil Herbs Diet Education General Awareness Skill Building 47

    48. Types of Medications Methylphenidate -Ritalin Dextroamphetamine - Adderal Atomoxetene - Strattera Dexmethylphenidate - Focalin Antidepressants SSRI’s Tricyclics

    49. Basic Elements of Stimulents Known as: Ritalin, Ritalin SR, Ritalin LA, Concerta, Metadate ER, Metadate CD, Daytrana, Adderal, Vyvanse Pharmacology: It is a CNS stimulant, which is chemically related to amphetamine Half-Life – 3-4 hours; 6-8 hours for sustained release, longer for Vyvance and Daytrana It’s a schedule II controlled substance, requiring a triplicate prescription

    50. Basic Elements, cont’d Adverse Drug Reactions Nervousness and insomnia; can be reduced by decreasing dose. Cardiovascular – Hypertension, tachycardia, and arrhythmias. CNS – Dizziness, euphoria, tremor, headache, precipitation of tics and Tourette’s syndrome, and rarely psychosis. GI – Decreased appetite, weight loss. Case reports of elevated liver enzymes and liver failure. Hematological –Leukopenia and anemia have been reported Growth Inhibition

    51. Daytrana Similar Side effects Less Upper GI problems Takes approx 1 hour Lasts 2-3 hours after removed Can be split 10, 15, 20, and 30 mg Cannot be shared

    52. Basic Elements of Dextroamphetamine Known as: Adderall, Adderall XR, Vyvanse Pharmacology:causes the release of norepinepherine from neurons. At higher doses, it will also cause dopamine and serotonin Half-Life – 10-25 hours It’s a schedule II controlled substance, requiring a triplicate prescription

    53. Basic Elements of Atomoxetene Known as: Strattera Pharmacology:works via presynaptic norepinepherine transporter inhibition. Half-Life – approximately 4 hours Not a schedule II controlled substance

    54. Atomoxetene, cont’d Adverse Drug Reactions Cardiovascular – increased blood pressure and heart rate (similar to those seen with conventional psychostimulant). BI – Anorexia, weight loss, nausea, abdominal pain. Miscellaneous – Fatigue, dry mouth, constipation, urinary hesitancy and erectile dysfunction.

    57. Vyvanse Pro drug Dexamphetamine (Adderall) A prodrug is a therapeutically inactive precursor of a drug converted to its active form by natural metabolic processes. More consistant release Longer lasting – still augmented

    58. Newest Medication Intuniv- (long acting Tenex) alpha2A-adrenergic receptor agonists treats high blood pressure by decreasing heart rate and relaxing the blood vessels so that blood can flow more easily through the body

    59. Other medications Dexadrine Paxil Wellbutrin Zoloft Trileptal Celexa/Lexapro Effexor

    60. Other Interventions Diets Carbohydrate/Protein-balanced Diet Management of Food Sensitivities in ADHD Patients The Feingold Diet for ADHD Artificial (synthetic) coloring Artificial (synthetic) flavoring Aspartame (Nutrasweet, an artificial sweetener) Artificial (synthetic) preservatives BHA, BHT, TBHQ Nutritional Supplementation Some children and adults with ADHD have responded favorably to a relatively high-protein, low (or complex)- carbohydrate, sugar-free diet. Although the reported benefits are primarily anecdotal, the literature does include some reference to a calming effect and improved learning with such diets. (Conners, 1987; Prinz). There appears to be no reliable predictor of the efficacy in treating ADHD with these changes in diet, although the advocates will often suggest such guidelines for a nutritionally sound dietary foundation. Diets high in sugar and refined carbohydrates tend to be associated with poor nutrient density, inadequate vitamins and minerals, and low dietary fiber, contributing to malnutrition. In at least some vulnerable children, high-sugar diets may also aggravate or potentiate disturbances in blood sugar control, disturbances in bowel flora, and the increased production of inflammatory reactions in metabolism (advanced glycosylation end-products). Some children and adults with ADHD have responded favorably to a relatively high-protein, low (or complex)- carbohydrate, sugar-free diet. Although the reported benefits are primarily anecdotal, the literature does include some reference to a calming effect and improved learning with such diets. (Conners, 1987; Prinz). There appears to be no reliable predictor of the efficacy in treating ADHD with these changes in diet, although the advocates will often suggest such guidelines for a nutritionally sound dietary foundation. Diets high in sugar and refined carbohydrates tend to be associated with poor nutrient density, inadequate vitamins and minerals, and low dietary fiber, contributing to malnutrition. In at least some vulnerable children, high-sugar diets may also aggravate or potentiate disturbances in blood sugar control, disturbances in bowel flora, and the increased production of inflammatory reactions in metabolism (advanced glycosylation end-products).

    61. Other Interventions cont’ Chelation Therapy for Lead EEG Biofeedback Herbal Medicine Movement Therapy Sensory Integration Therapy 61

    62. On Meds/Change of Meds Increased anxiety Increased depression Increased emotional libility Increased mood swings Increased compulsions

    63. Closing Thoughts on Meds Stimulants still first line defense Look at choice of drug based upon time of release Be aware of study sponsor Addictive nature Subscribe to Medscape

    64. Case Case 1: Case 2: Case 3: Case 4: Case 5: 64

    65. Case Case 1: Inattentive ADHD Case 2: Case 3: Case 4: Case 5: 65

    66. Case Case 1: Inattentive ADHD Case 2: ADHD and Tic disorder Case 3: Case 4: Case 5: 66

    67. Case Case 1: Inattentive ADHD Case 2: ADHD and Tic disorder Case 3: OCD Case 4: Case 5: 67

    68. Case Case 1: Inattentive ADHD Case 2: ADHD and Tic disorder Case 3: OCD Case 4: ODD Case 5: 68

    69. Case Case 1: Inattentive ADHD Case 2: ADHD and Tic disorder Case 3: OCD Case 4: ODD Case 5: LD, seizure, other 69

    70. Treatment Plans Medication Education General Awareness Skill Building 70

    71. Education Patient/Student/Client Parent Teacher Coach/Extra-curricular Student Body 71

    72. What each needs What ADHD is. What it isn’t. What does it mean. How does it affect ME. What can I do. 72

    73. Treatment Plans Medication Education General Awareness Skill Building 73

    74. Emotional sense of underachievement doesn’t deal well with frustration easily flustered and stressed out irritability or mood swings trouble staying motivated hypersensitivity to criticism short, often explosive, temper low self-esteem and sense of insecurity

    75. Hyper focusing Is a coping mechanism for distraction A way of tuning out the chaos Can become oblivious to everything going on around you – work and relationships Can completely lose track of time and neglect the things you’re supposed to be doing. Can be an asset

    76. Treatment Plans Medication Education General Awareness Skill Building 76

    77. Academics Take medication while doing homework Set a schedule to work on homework Minimize distractions Establish “study buddy” Use color to code calendar Minimize spaces Work on discovering what is really happening – forgetting homework

    78. Example of forgetting Many things go wrong in forgetting Lots of things over looked Emotions can run high Many people and places involved Breaking steps down

    79. Forgetting 1- Need to notice 2- Need to write/record 3- Need to bring home 4- Need to look 5- Need to understand 6- Need to start/finish 7- Need to store 8- Need to turn-in

    80. Academics Divide into smaller segments Use white noise Use daily/weekly forms Limit time spent on homework Review for ‘hasty’ errors Focus on school, remembering later

    81. School Problems & Symptoms Hyperactivity Give study breaks Reward completion Allow movement – multiple P.E. Depression Focus on small successes Provide support, not challenge to prove Defiance Give choices Teach problem solving Lower voice Use Time-out

    82. Behavior Modification Be very clear about what behavior is expected and make sure your child's understands this. Make sure that the expectation you have for your child is and appropriate for your child's age. Don't try to work on too many different things at one time.

    83. Behavior Modification Let your child participate in choosing the types of rewards he or she can earn Design the program so your child has a good chance to experience some initial success. Be sure to provide lots of social rewards (e.g. praise) in addition to the more tangible rewards that can be earned. Be consistent.

    84. Steps in Behavior Modification 1) Identify behavior 2) Chart behavior for baseline 3) Identify motivators 4) Establish realistic goals 5) Match motivators with behavior changes Short term Long term 6) Implement Plan 7) Evaluate Plan 8) Modify and repeat

    85. Measurable/Realistic Goal Measurable Long term and Short Term Goals What is the behavior? Who will measure? What is the goal? Where is the behavior now? When will we measure? How will we measure? 85

    86. Consequences

    87. Consequences examples

    88. Examples Smoking Over-eating Anxiety Depression Homework Completion Uncommunicative Parents 88

    89. Bribing?? Bribe to get someone to do something they shouldn’t Work ethic is to reward for doing what they should Intrinsic verses Extrensic 89

    90. Classroom Rewards Homework reductions Physical Contact Computer Access Additional recess Free time in class Tickets/stickers Time to finish homework in class Special pen or paper

    91. Home based Rewards Time with parent Dinner choices Computer Access Stay up later Reduction in other chores Tickets/stickers Screen Time Special outing – w/ or w/o parent

    92. Other Behavior Interventions Token Economy Time outs

    93. Token Economies Give immediately Can be punishment (name on board) Can be reward (marbles in jar) Give, don’t take

    94. Time-outs Not - “stand in corner” Not punishment Time to “cool off” and rethink Procedure Call time out early Establish time-in Think about YOUR actions don’t prepare for battle

    95. Other Recommendations Communicating expectations in spoken and written words (i.e., brush teeth, wait your turn, etc.) Setting up routines (homework, playtime, meals with family, bedtime) Choosing battles (ignore a little fidgeting and offer praise when he sits still) Using the time-out method when unwanted behavior occurs

    96. Other Recommendations Using the “when and then” method for modifying unwanted behaviors; for example, “when” he climbs all over the clothing racks while shopping, “then” he will need to spend more time helping with chores at home Using color charts at home to track progress of behavior (use his favorite color for good behavior, and his least favorite for bad)

    97. Group Interventions Social skills training groups Cognitive behavioral therapy groups Parent education groups/Parenting skills classes Some children and adults with ADHD have responded favorably to a relatively high-protein, low (or complex)- carbohydrate, sugar-free diet. Although the reported benefits are primarily anecdotal, the literature does include some reference to a calming effect and improved learning with such diets. (Conners, 1987; Prinz). There appears to be no reliable predictor of the efficacy in treating ADHD with these changes in diet, although the advocates will often suggest such guidelines for a nutritionally sound dietary foundation. Diets high in sugar and refined carbohydrates tend to be associated with poor nutrient density, inadequate vitamins and minerals, and low dietary fiber, contributing to malnutrition. In at least some vulnerable children, high-sugar diets may also aggravate or potentiate disturbances in blood sugar control, disturbances in bowel flora, and the increased production of inflammatory reactions in metabolism (advanced glycosylation end-products). Some children and adults with ADHD have responded favorably to a relatively high-protein, low (or complex)- carbohydrate, sugar-free diet. Although the reported benefits are primarily anecdotal, the literature does include some reference to a calming effect and improved learning with such diets. (Conners, 1987; Prinz). There appears to be no reliable predictor of the efficacy in treating ADHD with these changes in diet, although the advocates will often suggest such guidelines for a nutritionally sound dietary foundation. Diets high in sugar and refined carbohydrates tend to be associated with poor nutrient density, inadequate vitamins and minerals, and low dietary fiber, contributing to malnutrition. In at least some vulnerable children, high-sugar diets may also aggravate or potentiate disturbances in blood sugar control, disturbances in bowel flora, and the increased production of inflammatory reactions in metabolism (advanced glycosylation end-products).

    98. Group Interventions Can deal with: Time management Managing the Negative Self Critic Relationship Communication Finding Vocational Choices Coping with Career changing Coping with Losses Accepting Oneself Some children and adults with ADHD have responded favorably to a relatively high-protein, low (or complex)- carbohydrate, sugar-free diet. Although the reported benefits are primarily anecdotal, the literature does include some reference to a calming effect and improved learning with such diets. (Conners, 1987; Prinz). There appears to be no reliable predictor of the efficacy in treating ADHD with these changes in diet, although the advocates will often suggest such guidelines for a nutritionally sound dietary foundation. Diets high in sugar and refined carbohydrates tend to be associated with poor nutrient density, inadequate vitamins and minerals, and low dietary fiber, contributing to malnutrition. In at least some vulnerable children, high-sugar diets may also aggravate or potentiate disturbances in blood sugar control, disturbances in bowel flora, and the increased production of inflammatory reactions in metabolism (advanced glycosylation end-products). Some children and adults with ADHD have responded favorably to a relatively high-protein, low (or complex)- carbohydrate, sugar-free diet. Although the reported benefits are primarily anecdotal, the literature does include some reference to a calming effect and improved learning with such diets. (Conners, 1987; Prinz). There appears to be no reliable predictor of the efficacy in treating ADHD with these changes in diet, although the advocates will often suggest such guidelines for a nutritionally sound dietary foundation. Diets high in sugar and refined carbohydrates tend to be associated with poor nutrient density, inadequate vitamins and minerals, and low dietary fiber, contributing to malnutrition. In at least some vulnerable children, high-sugar diets may also aggravate or potentiate disturbances in blood sugar control, disturbances in bowel flora, and the increased production of inflammatory reactions in metabolism (advanced glycosylation end-products).

    99. Helping a child control his behavior Daily Schedule Cut down distractions Organize your house Set small, reachable goals Limit choices Use calm discipline - distraction

    100. Scheduling Use a system Colors Visible Understandable Teachable Multiple Reminders

    101. Homework Tips Set a time Have a box Have a place Watch for fatigue Timers, distractions, helpers

    102. Other Activities Organize Reward yourself, appropriately Know you limits Walk away Explain yourself

    103. Time Management Calendars Phones Organize your things Boxes Touch once Develop a schedule Use everywhere

    104. Adult Impulsivity If you are overly excited or angry try giving yourself time to cool off before making any decisions. Before you start anything, determine your goal. If you don't know where you are going, how will you get there? To avoid impulsive purchases at the grocery store, plan your meals out before you make up your shopping list. This will also save time because you will know exactly what you need to buy.

    105. Adult Impulsivity Instead of an impulsive "yes" to every request people make of you, learn to say no nicely but firmly. If you can't muster up the wherewithal to say no at the time of the request, say "Let me think about that and get back to you." Wait a day and then give your answer. This will give you the time you need to figure out if you can realistically commit to the request or not.

    106. Adult Impulsivity For the impulsive shopper. Try writing down the following questions and carry them with you. Pull these out and read them whenever you are see something you want to buy: a) Do I really need this? b) Will I use it within the next month? c) How many more of these do I already have at home? d) Will the high that I feel from purchasing this item last? e) Can I really afford this?

    107. Adult Impulsivity Before starting a new project do your thinking on paper. You will make quicker and better decisions if you write down the pros and cons of a line of action. This doesn't take time, it saves time. Try turning your answering machine on 15 minutes before you need to leave the house to avoid answering the phone at the last minute, making yourself late to work or appointment.

    108. Adult Impulsivity If you are an impulsive spender, try taking a limited amount of money with you when you go out. If you see something you want to purchase, by the time you go back home for more money you are likely to realize that you do not want the item after all. Mary Jane Johnson, 2005

    109. Relationships Issues Impulsivity: difficulty thinking through consequences of actions. Need for Stimulation: high stimulation activities in beginning of relationship. Later, relationship becomes boring. Conflict Seeking Behavior: one way to get stimulation is by subconsciously provoking arguments. Forgetfulness: appointments, where you put things, people's names, etc.

    110. Relationships Issues Poor Communication Skills: difficulty with listening and verbalizing. brains are racing ahead to next thought. Lack of Organization: piles of laundry or paperwork due to distractibility. Poor Follow Through: difficulty completing tasks.

    111. Final thoughts on wondering minds Give them a good seat Provide a review Watch for fatigue Let them “move”

    112. Tools/Resources ADD/ADHD Behavior-Change Resource Kit Teenagers with ADD: A Parents’ Guide www.myadhd.com www.adhdhelp.com www.LouisvilleDFT.com

    113. References American Academy of Pediatrics. Diagnosis and evaluation of the child with attention-deficit/hyperactivity disorder. Pediatrics. 2000;105:1158-1170. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. DSM-IV-TR. In: Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence: Diagnostic Criteria for Attention-Deficit/Hyperactivity Disorder. Washington, DC: American Psychiatric Association; 1994:92-93. National Institute of Mental Health. National Institutes of Health. Attention deficit hyperactivity disorder. Available at: http://www.nimh.nih.gov/publicat/helpchild.cfm. Accessed April 19, 2002. U.S. Department of Health and Human Services. Mental Health: A Report of the Surgeon General. Available at: http://www.surgeongeneral.gov/library/mentalhealth/chapter3/sec4.html. Accessed April 19, 2002. Dulcan M. Practice parameters for the assessment and treatment of children, adolescents, and adults with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 1997;369(suppl):855-1215. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. DSM-IV-TR. In: Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence: Diagnostic Criteria for Attention-Deficit/Hyperactivity Disorder. Washington, DC: American Psychiatric Association; 1994:92-93. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. DSM-IV-TR. In: Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence: Diagnostic Criteria for Attention-Deficit/Hyperactivity Disorder. Washington, DC: American Psychiatric Association; 1994:92-93. National Institute of Mental Health. National Institutes of Health. Attention deficit hyperactivity disorder—questions and answers. Available at: http://www.nimh.nih.gov/publicat/adhdqa.cfm. Accessed April 19, 2002. National Institute of Mental Health. National Institutes of Health. Attention deficit hyperactivity disorder—questions and answers. Available at: http://www.nimh.nih.gov/publicat/adhdqa.cfm. Accessed April 19, 2002. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000. Fauman, M. A. (2002). Study Guide to DSM-IV-TR. Washington, DC: American Psychiatric Publishing, Inc.

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