Post on 24-Feb-2016
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1. What medications are used to treat ADHD? Why is a cortical stimulant prescribed when a child is hyperactive?
2.What is the difference between ADHD and auditory processing problems?
3. What problems are seen with ADHD in school aside from academic issues?
4. Can Celiac Disease, sensory difficulty, etc. cause ADHD symptoms?
5. What differences are found in the cerebral cortex of individuals diagnosed with ADHD and normal individuals?
6. Is there a relationship between ADHD and OCD?
7. What are the comorbid conditions associated with ADHD?
8. How is ADHD diagnosed? Is it diagnosed differently in adults and children?
9. What are executive functions?
10. Will colleges accept students diagnosed with ADHD?
11. Can teens or adults develop ADHD?
12 .Do people with ADHD complain of sleep disorders?
13. What is ODD and how is it related to ADHD?
14. Do students with ADHD suffer from anxiety? What happens if the problem is anxiety and not ADHD?
15. What are the similarities and differences between Cocaine and Ritalin?
16. Is there a specific remarkable history found in individuals with ADHD?
17. Can a special diet help individuals who have ADHD?
18. Why are there difficulties with transitions in individuals diagnosed with ADHD?
19. How prevalent is ADHD?
20. Is there a relationship between ear infections and ADHD?
21. What are the differences in symptoms and diagnosis of ADHD in adults?
22. How does ADHD affect academic success?
23. Why does it take more time for an individual with attention issues to learn?
24. When does ADHD begin?
25. What are some of the treatments for ADHD?
26. What can a student with ADHD do to improve performance?
27. Do food additives affect ADHD?
28. What makes diagnosis difficult? Why is it missed?
29. What is the relationship between ADHD and reading disorders?
30. What is internal speech? What is the relationship b/w internal speech and attention?
31. Can counseling help an individual with ADHD?
32. Why do ADHD individuals wait until the very last minute to do things?
33. What is the difference between remediation and accommodations?
34. Why is the symptom presentation so variable with ADHD? Why do only some individuals show impulsivity?
35. What can teachers do to help ADHD individuals?
• Stimulants • Sharpen concentration and increase the
activity of the brain chemicals called dopamine and norepinephrine, which are believed to be imbalanced in adults with ADHD.
• The FDA has approved several stimulants for the treatment of adult ADHD.
• In some individuals a stimulant is contraindicated because of seizures, worsening depression, etc.
• Non-stimulant options also exist.
Medications for ADHD
Problems occur when the medication runs out in the middle of the day or when the medication keeps the individual awake at night
The relatively new ADHD medication Daytrana is composed of the same chemical compound as Ritalin and Concerta (methylphenidate),
Daytrana offers the distinct advantage of existing in the patch form, which is typically worn on the hip. At the present moment, this medication is used exclusively for children with ADHD and related disorders, although it can also be used off-label for adults with the disorder.
Medications
remains the most popular choice of medications for individuals with ADHD. However, the combination of dosing difficulties and negative side effects connected with oral administration left room for an alternate form of delivery: the methylphenidate transdermal delivery system, more commonly known as Daytrana.
Methylphenidate
A new drug called Vyvanse (Lisdexamfetamine) has entered the world of ADHD stimulant medications relatively recently.
Vyvanse was originally marketed as an ADHD treatment for children, but was approved by the FDA for adult and adolescent use this past April. A cousin of the popular ADHD medications Dexedrine and Adderal, Vyvanse includes some key modifications of these medications.
Vyvanse
ADHD individuals have less energy in the brain which is why they fidget or through paper airplanes.
Functioning for them is like trying to work when you are very tired and uninterested in the work at hand.
If a student is already hyperactive why are doctors
prescribing a stimulant?
Pet Scan shows much less energy used by an ADHD individual
Because auditory processing disorders and ADHD have very similar symptoms, many ADHD individuals are not diagnosed with auditory processing disorders because they are never tested for it.
While auditory processing disorders affect the student during class lectures, it is not a diagnosis that will get accommodations for tests (except oral tests) since it does not affect the written aspect of test taking.
Confusing ADHD and Auditory Processing Difficulty
Auditory processing disorders are independent from the mechanical process of hearing (in other words, the peripheral hearing, or ability to pick up background sounds is not affected), but rather have difficulties in the screening, filtering and differentiating "important" sounds from background noise. Difficulties in this result in an impaired ability to utilize important auditory information properly.
Auditory Processing Disorders
ADHD and Auditory Processing Disorders can share a number of overlapping symptoms and behaviors in children. However, when these two disorders exist alongside each other as comorbid disorders, then the two can feed off of each other and increase the likelihood of onset of a third (or fourth) psychological or developmental disorder.
ADHD and Auditory Processing Disorders
Fighting in School and repeated arguments are
common
One of the biggest challenges in diagnosing and treating ADHD is trying to separate it out from other disorders that often present similar-looking symptoms. One such disorder is known as celiac disease. When gluten (a type of plant protein found in corn and wheat and other carbohydrates) is ingested in individuals with celiac disease, an inflammatory response in the upper portion of the small intestine occurs. When repeatedly challenged by gluten exposure, damage can occur to this portion of the digestive system, which leads to painful symptoms and impaired digestive and absorptive function.
Celiac Disease causes ADHD Symptoms
Sensory processing disorders are often seen in the ADHD population, especially in children. This includes more "physical" dysfunctions including the ability of the child to maintain balance and equilibrium.
To the frustrated parent of coach of an ADHD child, this may introduce another complication with regards to sports or other activities which involve coordination and balance, such as basketball, baseball, tennis, soccer, gymnastics, musical instruments, dance, etc.
Sensory Processing Disorders
Cerebral Differences - Pet Scan shows much less energy used by an ADHD individual
Pet Scan measuring metabolic rate with ADHD
and nonADHD Cortex
These positron emission tomography (PET) scans show that patients with ADHD had lower levels of dopamine transporters in the nucleus accumbens, a part of the brain's reward center, than control subjects.
The researchers studied brain scans of 24 ADHD children (with hyperactivity) and found that the right parietal lobes in children with ADHD did not function as well as in children without ADHD. The right parietal lobes are associated with the development of coping strategies.
Using the fMRI there is evidence that ADHD individuals do not use the right hemisphere to the same extent as non ADHD individuals. This region is involved in self concept.
ADHD Individuals Have Less Volume in the Prefrontal Cortex
The areas that organize and direct behavior are smaller
The area that is responsible for holding and computing is smaller
The area of the brain responsible for self concept is not utilized as much.
Differences in the Cortex of ADHD and nonADHD individuals
There is less energy used by the brain of people diagnosed with ADHD so they sort of feel like they can’t get enough energy
The areas that organize and direct behavior are smaller
The area that is responsible for holding and computing is smaller
The area of the brain responsible for self concept is not utilized as much.
Cortical Differences Between ADHD Individuals and Others
A number of studies have confirmed the hypothesis that individuals with ADHD have reduced bloodflow levels marking a recuction of activity to multiple key brain regions
Differences in Brain Activity Between ADHD and nonADHD
Oppositional Defiant Disorder is a disorder in which a child exhibits
disobedience, irritability and hostility towards authority figures beyond the range of normal age-appropriate behaviors.
Of course there is a significant gray area with regards to what is age appropriate, especially when the child's environment is considered.
ODD
Major Depressive Disorder, Oppositional Defiant Disorder, General Anxiety Disorder(Depression sometimes is expressed as angry outbursts especially in children)
20.8% had MDD. 20.8% ODD. 18.6% GAD. Many undiagnosed individuals are
considered under achievers. Parents usually use other words.
Comorbid Conditions Predominantly Inattentive
Oppositional Defiant Disorder, General Anxiety Disorder
41.9% had ODD. 22.2% GAD. 19.4% MDD.
In predominantly hyperactive-impulsive subtype
50.7% had ODD. 22.7% MDD. 12.4% GAD.
In combined subtype:
Total Sample: 3082 AD/HD all types: 222 Inattentive subtype: 95 Combined type: 72 Hyperactive-Impulsive type: 55
This data were reported in Prevalence, Recognition, and Treatment of Attention-Deficit/Hyperactivity Disorder in a National Sample of US Children, (Archives of Pediatrics & Adolescent Medicine, September 2007).
Some are emotional Some are other learning disabilities Some are behavioral Some have to do with relationships Other learning disabilities
There are a Number Conditions and Problems Associated with ADHD
The percentage of each condition depends on who does the study
Comorbid Conditions
Another Site with Comorbid Conditions
There is no standard battery of tests. History is very important. This includes family, social, academic
as well as medical history. On the IQ there are usually indicators that the processing speed is
slow and there are difficulties with working memory. On the fluency tests, there are indicators that the individual has
difficulty with timed tasks. There are instruments given to the parents and teachers to get
feedback regarding the students’ performance in class. There are tests that measure continuous performance and these
often indicate difficulty. Memory is often compromised, especially short term memory.
What Tests are Used to Diagnose ADHD?
The Stroop Test
Often Speeded Tests are used to Help Make the Diagnosis of ADHD
Symbol search: This subtest of the IQ test involves identifying whether a particular symbol is present in a row of symbols. It has direct implications on one's ability to pay attention to detail as well as the ability to quickly scan through information to find what is relevant.
The improvements in post-methylphenidate scores were about twice as large for the non-anxiety group of ADHD children for tests like symbol search.
Arithmetic: This is a timed test on the IQ in which arithmetic questions are orally presented to the children and the responses are measured, assessing both speed and accuracy.
With this subtest there was little help with medication, no help if there is comorbid anxiety
Managing frustration Restraining outbursts Problem solving Memory recall Sustaining effort Focusing Organizing Planning
Activities Controlled by Executive Function Include:
Those that involve planning or decision making.
Those that involve error correction or troubleshooting.
Situations where responses are not well-learned or contain novel sequences of actions.
Dangerous or technically difficult situations. Situations which require the overcoming of a
strong habitual response or resisting temptation.
The Five Types of Executive Function
Students with a documented disability can get various services.
Services are usually supplied at a fee. Students who qualify can get the reasonable
and necessary accommodation of extended time and a low distraction environment.
Students should check the college web site which will explain what documentation is necessary in order to receive accommodations.
Colleges Have an Office of Disabilities
• ADHD is related to brain physiology and does not develop spontaneously.
• Adults diagnosed with ADHD had symptoms as a child, but sometimes their teachers made informal accommodations for them.
• Some individuals do poorly in school, because they had ADHD but were not diagnosed
• The ratio of males to females seems to even out by adulthood.
Can a Teen or Adult Develop ADHD?
scientific explanation behind reasons why ADHD children stay up until three in the morning on a consistent basis.while impulsivity is often more associated as a "morning" behavior, the inattentive subcomponent of ADHD appears to be more affiliated with the evening. Omega-3 deficiencies may disrupt circadian rhythms possibly due to an impairment in melatonin production (melatonin, a hormone, is associated with the sleep-wake cycle and has implications on the circadian rhythm patterns).
The connection between ADHD and circadian rhythms:
Always seen with another diagnosis Most likely this will be ADHD It is a willful pattern of disobedience
What is Oppositional Defiant Disorder?
Oppositional Defiant Disorder is a disorder in which a child exhibits
disobedience, irritability and hostility towards authority figures beyond the range of normal age-appropriate behaviors.
Of course there is a significant gray area with regards to what is age appropriate, especially when the child's environment is considered.
ODD
By and large, it appears that memory-based tasks are the hardest hit by an accompanying anxiety disorder when methylphenidate is administered as an ADHD treatment.
ADHD and Anxiety
For the teacher, however, an improvement in classroom behavior due to medication, but a lack of improvement in academic work (especially in memory-related tasks) may be a tip-off that an undiagnosed accompanying anxiety disorder may be in place in this ADHD child.
What Happens if the Classroom Behavior Improves
with Medication, but Academics Don’t
SIMILARITY: Uptake patterns into the brain: Both methylphenidate and cocaine enter the brain at similar rates and target similar specific regions of the brain.
Brain Regions Targeted by each drug: In addition to similar uptake patterns in the brain between the two drugs, there is a relatively large degree of overlap for particular brain regions targeted.
What are the similarities and Differences between
Cocaine and Ritalin?
the method of delivery not only affects the speed of uptake of a drug (injected is almost always faster than snorted, which is almost always faster than ingested), but also the actual brain regions targeted by the drug.
the Nucleus Accumbens is targeted by cocaine and injected methylphenidate. However, when methylphenidate, such as Ritalin, Concerta or Metadate is taken orally, this nucleus accumbens region is not targeted (at least not anywhere near the level of injection).
Differences Between Ritalin and Cocaine
The nucleus accumbens is believed to play an important role in the addiction potential of a number of drugs, including many stimulant medications.
Thus, proper use of the methylphenidate medication actually bypasses a key brain region believed to be critically involved in the "high" or addiction process of a stimulant drug.
Addiction and ADHD DRUGS
Low birth weight, which has a number of implications for other disorders, was found to be a good indicator of childhood conduct problems appearing alongside of ADHD in its own right. It is believed that low birth weight is a good indicator of a poor prenatal environment, which is why so many disorders and developmental issues are often associated with low birth weights.
Low Birth Weight (Less than 5.5lbs)
The main culprit for attentional deficits is often believed to be the result of hearing loss (even mild), early in a child's life due to complications with the middle ear, including infections, allergy-related causes or build-up of fluids in the canal.
As a result, the child begins to miss out on verbal cues, and does not develop the same level of response to an adult voice.
Ear Infections and ADHDAre they Related?
During early childhood, the actual positioning of the ear canal is still adjusting, the pathway into the middle part of the ear is actually at a flatter angle than in a mature adult. This difference in positioning actually makes younger children much more prone to ear infections than older children or adults. These infections increase the risk of further complications down the road, including an increased onset of attention difficulties, including ADHD.
Ear Infections
This is a controversial area: Some experts believe foods that provide
quality brain fuel could reduce symptoms. High-protein foods, including nuts, meat, beans
Replacing simple carbs with complex carbs, like whole-grain pasta levels blood sugar levels
Avoid sugar and artificial colors
Does Diet Help?
It consistently has been shown that individuals with ADHD are often deficient in omega-3 fatty acids.
Low blood sugar has been linked to difficulty with concentration, and therefore worsens ADHD
High protein diets may be helpful for ADHD individuals
Diet and ADHD
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ADHD occurs because how the individuals cerebral cortex is formed and functions
These specific structures affect how other structures which are adjacent to them and who have communication with them function.
Because the structures are identified and the difficulty with them are consistent from individual to individual, the symptoms are very similar
Why are There Differences with Transitions?
Proximity of the corpus callosum to the cingulate
gyrus1, Rostrum of corpus callosum 2. Genu of corpus callosum 3 .Body of corpus callosum 4. Splenium of corpus callosum 5. Septum pellucidum 6. Anterior commissure 7. Fornix 8. Hippocampus 9. Cingulate gyrus 10.Paraterminal gyrus
Note the proximity of this corpus callosum brain region to the cingulate gyrus a region. The
cingulate region can be thought of as the brain's "gear shifter". If
underactive, it leads to consistent lack of focus on one thought or
task (a hallmark characteristic of ADHD), if overactive, the cingulate
can result in overfocus (a characteristic of obsessive
compulsive disorder, or OCD). This is also the reason ADHD individuals
get lost in a task.
Centers for Disease Control and Prevention (CDC) publication Vital and Health Statistics (PDF; September 2007).
There are 4.5 million children ages 3 to 17 (7% of this age group) with AD/HD.
Boys are more than twice as likely to have AD/HD, with 11% of boys in this age range having the disorder and 4% of girls.
When compared with children who have excellent or very good health, children who have fair or poor health status are nearly 3 times more likely to have AD/HD (7% vs. 19%).
How Prevalent is ADHD
CDC
Percent of Youth 4-17 diagnosed with ADHD
ADHD is more often diagnosed in boys
ADHD afflicts approximately 3% to 5% of school-age children
An estimated 60% of those maintain the disorder into adulthood. (That means the symptoms still create some level of distress in 60% of adults.
How Many Adults have ADHD?
The main culprit for attentional deficits is often believed to be the result of hearing loss (even mild), early in a child's life due to complications with the middle ear, including infections, allergy-related causes or build-up of fluids in the canal.
As a result, the child begins to miss out on verbal cues, and does not develop the same level of response to an adult voice.
Ear Infections and ADHDAre they Related?
During early childhood, the actual positioning of the ear canal is still adjusting, the pathway into the middle part of the ear is actually at a flatter angle than in a mature adult. This difference in positioning actually makes younger children much more prone to ear infections than older children or adults. These infections increase the risk of further complications down the road, including an increased onset of attention difficulties, including ADHD.
Ear Infections
Many parents don’t learn that they have ADHD until they get help for their child or if they complain of mood disorders like anxiety or depression.
To confirm the diagnosis, a practitioner must verify that symptoms were present in childhood even if it was not formally diagnosed.
The same type of tests are used for both children and adults.
Diagnosing ADHD in Teens and Adults
Some symptoms disappearADHD affects males at higher rate than
females in childhood, but this ratio seems to even out by adulthood.
Many boys are erroneously diagnosed because of brain growth
Many girls are not diagnosed and labeled underachievers
What happens to ADHD in ADULTS
• Chronic lateness and forgetfulness. • Anxiety = the result of worrying about symptoms• Low self-esteem. • School problems become Employment problems. • Difficulty controlling anger. • Impulsiveness. • Substance abuse or addiction. • Poor organization skills. • Procrastination. • Low frustration tolerance. • Chronic boredom. • Difficulty concentrating when reading. • Mood swings. • Depression = the result of being distressed by symptoms. • Relationship problems.
How Do Symptom Patterns in Adults Differ?
Poorer educational performance (underachievers)
Frequent school disciplinary actions. Grade Retention Adults with ADHD have dropped out of
school more often.
History of ADHD Adult
• Lower socioeconomic status. • Driving violations such as: be cited for
speeding; have their licenses suspended; be involved in more crashes; rate themselves and others as using poorer driving habits.
• Use drugs and alcohol more frequently • Smoke cigarettes • Self-report psychological maladjustment
more often
Issues Found in Adults with ADHD
Change employers frequently and perform poorly.
Have had fewer occupational achievements. More relationship failures
Adults with ADHD
Trouble getting projects done within a specific time frame
Trouble getting tests done within a specific time frame
Lower scores on tests than on class projects
Lower scores on standardized tests than on class tests
Functional Limitations
Most Individuals diagnosed with ADHD Need more time to complete assignments
and tests
Difficulty keeping attention on a specific task.
Not being able to integrate information occurring in the environment when the task at hand is very interesting.
Difficulty with time management. Not listening when being talked to directly.
Sensitivity to Distractions
A combination of reasons: 1. The student tends to be easily
distracted by internal as well as external noises
2. The individual’s working memory (the ability to hold and manipulate data) does not work as well.
New tasks take more sustained attention. ADHD students have difficulty with sustained attention.
Why does it take longer for an ADHD student to learn
something?
An ADHD individual has difficulty keeping out distractions. His brain works on the premise that you let in all distractions or you keep out all distractions. If you let them in, then every sound in the room catches his attention. Every time the air conditioner turns on, every time someone turns a page, every time the clock ticks.
The other thing the student does is to keep out all distractions. In that case nothing is let in. He doesn’t hear that you’ve called him, he doesn’t notice what time it is, he blocks out everything.
Distractions
The process of neurite outgrowth is a major indicator of overall cell health with regards to the nervous system. Additionally, this process is especially critical during the neurodevelopmental stages, which starts during embryonic development, and can continue on until an individual is in his or her 20's. However, the period of greatest development (and greatest potential sensitivity to chemical agents), is between the sixth month of gestation to the first few years after birth.
ADHD Usually Begins in utero
Remediation Structure Medication Accommodations Feedback Using technology
What is the Treatment for ADHD
The student chooses to use various methods to help with organization and structure.
Calendars, colored pencils, lists, etc. When the student is young this process is
supported by teachers and parents As the student matures, the student takes over
the process The student asks for assistance in organization,
etc. The student learns to take an active role in the
learning process.
Remediation
The student learns methods that help with organization (putting keys and personal belongings in a specific place; looking behind as the student leaves to assure that nothing is left behind, etc.)
The student has a specific place to study where there are few interruptions and where everything he needs is located (pens, staplers, etc.)
The student puts aside adequate time for studying and projects.
Structure
Focus on organization skills, such as taking notes, keeping a daily planner, and prioritizing a to-do list.
Put personal articles in the same place every time
Use technology – there are a variety of devices that can help with study and production.
What Helps?
Brilliant Blue, also referred to as "Blue1" and "E133" (in Europe)
Quinoline Yellow, also referred to as Yellow 13 or E104
Aspartame (Nutrasweet, Equal): and artificial sweetener often used in diet soft drinks
MSG: short for Monosodium Glutamate or a salt form of L-glutamic acid, often used in Chinese foods and, (to a lesser extent now), potato chips and french fries
The Four Food Additives in Question were as follows:
The investigation into synergistic effects of food additives stems from an article done by Lau and coworkers on how four food additives, well-known for their potential neurotoxic effects as individual agents, can potentially be even more devastating when used in combination.
The levels of these different chemical agents done in the study by Lau were below concentrations which typically cause neurotoxic problems on their own.
Brilliant Blue, when combined with MSG, showed a strong decrease in a process called neurite outgrowth.
the combination of Quinoline Yellow and Aspartame also showed a strong additive effect on inhibiting neurite outgrowth.
Results of the Study
Trajectory differences create different functional levels in boys and girls which is not accounted for in most tests.
There are different types of ADHD There are many conditions with similar symptoms Symptom effect differs with IQ and with the seriousness of the
condition as well as with comorbid conditions It can present without any hyperactivity and be confused with
low achievement or low motivation It can be mistaken for “laziness” It is prevalent in young children who have difficulty explaining
the problem. It can be very annoying and mistaken for a behavioral problem.
What makes Diagnosis Difficult?
ADHD disappears with one-on-one interactions
There is no specific test for ADHD It can be mistaken for a reading problem Symptoms change over time
The comorbidity of Reading Disorder and ADHD is higher than for any other learning disorder
When children have difficulty with sound/symbol relationships, it takes them longer to finish a reading task. Elongated tasks are often automatically considered an ADHD difficulty.
Since there is no specific test for ADHD, the practitioner may not rule out a Reading Disorder unless tests are given to rule it out.
Why are Reading Disorders often Mistaken for ADHD
Internal speech allows an individual to guide their thoughts to find the answer
What is internal speech and how does it help?
Therapy for individuals with ADHD often highlights self confidence. Many of these individuals have had a great number of failures because their ADHD was unrecognized for years and they were repeatedly told that they were not trying. Therapy often focuses on both remediation techniques as well as discussing the poor sense of self that has developed because of negativity.
Can Therapy Help ADHD Individuals?
• People often think the best treatment involves medication.
• Addressing poor habits and low self-esteem is even more critical.
• ADHD individuals should focus on organization, routines, repairing relationships, and improving social skills.
• Medication combined with counseling can ease ADHD symptoms and improve
Counseling for ADHD
Helps allow focusing Helps the individual set time limits Helps the individual set goalsHowever, most ADHD individuals have a
poor sense of how long it will take to finish a project, so while procrastination may improve focus, it often means the project is not finished on time.
Why is Pressure Helpful in Having ADHD
Individuals be Productive
Remediation is a strategy the student uses to compensate for a learning difficulty.
Accommodation is a compensation that is given to the student to allow the teacher to understand the breath of his knowledge
Modification is a change in the curriculum to compensate for the student’s learning issue.
Remediation vs. Accommodation
Many professionals who study ADHD believe that it is a diagnosis which has not been carefully examined. It is a mixture of a number of conditions, and therefore, the symptom pattern varies considerably from person to person. Additionally, ADHD symptoms are often present in other conditions such as anxiety.
Symptom Variability with ADHD
Use attention getting techniques Be interactive Break large projects into parts where there
are different due dates for each part Expect students to take notes on what they
are reading Show students how to set goals.
What Can Teachers Do?
blood flow patters to the brains of ADHD and OCD (Obsessive Compulsive Disorders) can show pronounced differences, which can aid the diagnostic process between these two disorders (while ADHD and OCD are often considered to be on "opposite" ends of the spectrum with regards to neuro-chemical signaling levels, these two disorders can often exhibit similar symptoms, such as a severe impairment in the response to verbal directions. This is especially true in younger children).
Is ADHD Linked to OCD?