Attention-Deficit Attention-Deficit Hyperactivity DisorderHyperactivity Disorder

What Is ADD?What Is ADD?

A disorder that is characterized by serious A disorder that is characterized by serious and chronic inattentiveness, impulsivity, and chronic inattentiveness, impulsivity, and hyperactivity and hyperactivity

Behaviors interfere with academic Behaviors interfere with academic performance and appropriate social skillsperformance and appropriate social skills

ADD ADD

ADD (Attention Deficit Disorder) is a ADD (Attention Deficit Disorder) is a disorder in which the most significant disorder in which the most significant characteristics are inattentiveness, characteristics are inattentiveness, distractibility, and disorganizationdistractibility, and disorganization

Hyperactivity is NOT presentHyperactivity is NOT present

ADHDADHD Attention-Deficit Attention-Deficit HyperactivityHyperactivity

Disorder is a disorder of serious, Disorder is a disorder of serious, chronic, and persistent forgetfulness, chronic, and persistent forgetfulness, hyperactivityhyperactivity, distractibility, difficulties in , distractibility, difficulties in attention span, impulse control which attention span, impulse control which can typically leads to poor academic can typically leads to poor academic performance performance

ADHD CharacteristicsADHD Characteristics

ADHD affects 8-12% of childrenADHD affects 8-12% of children They typically show problems with lack of They typically show problems with lack of

attention, sustaining effort, completing attention, sustaining effort, completing tasks, excessive movement, and tasks, excessive movement, and disorganizationdisorganization

Can exhibit other behaviors such as Can exhibit other behaviors such as depression, anxiety, oppositional defiance, depression, anxiety, oppositional defiance, and compulsive behaviorsand compulsive behaviors

Relationships With Family MembersRelationships With Family Members Academic Difficulties( Speech Problems, Academic Difficulties( Speech Problems,

Auditory Processing Difficulties, Reading, Auditory Processing Difficulties, Reading, Spelling, and Math)Spelling, and Math)

Social Interactions With Peers and AdultsSocial Interactions With Peers and Adults Disciplinary ProblemsDisciplinary Problems

Children tend to have difficulties in school Children tend to have difficulties in school and home environments often in the form of:and home environments often in the form of:

Learning DisabilitiesLearning Disabilities

Substance AbuseSubstance Abuse

CrimeCrime

CausesCauses The exact cause of ADHD is unknown, The exact cause of ADHD is unknown,

but research suggests that at least one of but research suggests that at least one of two major factors exist in most cases:two major factors exist in most cases:

I. Neurological CauseI. Neurological Cause A PET Scan (an image showing the A PET Scan (an image showing the

anatomy and metabolism)anatomy and metabolism)

In 1990, the New England Journal of In 1990, the New England Journal of Medicine published a landmark study by Medicine published a landmark study by researchers at the National Institute for researchers at the National Institute for Mental Health which documented the Mental Health which documented the neurobiological effects of ADHD through neurobiological effects of ADHD through brain imaging. The rate at which the brain brain imaging. The rate at which the brain uses glucose, its main energy source, was uses glucose, its main energy source, was shown to be lower in persons with ADHD, shown to be lower in persons with ADHD, especially in the portion of the brain that is especially in the portion of the brain that is responsible for attention, handwriting, responsible for attention, handwriting, motor control and inhibition responses. motor control and inhibition responses.

Children with ADHD show changes in the pathways Children with ADHD show changes in the pathways along which messages travel to the parts of the brain along which messages travel to the parts of the brain that control planning, behavior and voluntary that control planning, behavior and voluntary movement.movement.

Altered brain function and anatomy.Altered brain function and anatomy. While the exact While the exact cause of ADHD remains a mystery, researchers have cause of ADHD remains a mystery, researchers have discovered important differences in the brains of discovered important differences in the brains of people with ADHD. For example, neurotransmitters — people with ADHD. For example, neurotransmitters — the brain's chemical messengers — aren't used the brain's chemical messengers — aren't used properly in people with ADHD. Additionally, there properly in people with ADHD. Additionally, there appears to be less activity in the areas of the brain appears to be less activity in the areas of the brain that control activity and attention in people with ADHD. that control activity and attention in people with ADHD. In addition, brain scans have revealed that, on In addition, brain scans have revealed that, on average, children with ADHD have up to 4 percent average, children with ADHD have up to 4 percent smaller brain volumes than do children without ADHD. smaller brain volumes than do children without ADHD.

PET Scans typically find abnormally low PET Scans typically find abnormally low metabolism of glucose in the brains of metabolism of glucose in the brains of ADHD patientsADHD patients

Left: Normal Left: Normal Right: ADHDRight: ADHD

SPECT Scans find that people with SPECT Scans find that people with ADHD have reduced blood circulation ADHD have reduced blood circulation and a significantly higher concentration of and a significantly higher concentration of dopamine transporters in the dopamine transporters in the StriatumStriatum, , which controls one’s ability to think aheadwhich controls one’s ability to think ahead

II. GeneticsII. Genetics

Twin, Adoption, and Molecular Genetic Twin, Adoption, and Molecular Genetic Studies show that ADHD is probably Studies show that ADHD is probably inheritedinherited

If a parent has ADHD, he/she has an 80% If a parent has ADHD, he/she has an 80% chance of passing it to his/her childchance of passing it to his/her child

Some researchers believe that ADHD is due Some researchers believe that ADHD is due to a genetic defect that results in altered brain to a genetic defect that results in altered brain biochemistry. Differences in biochemistry are biochemistry. Differences in biochemistry are considered to be the cause of poor regulation considered to be the cause of poor regulation of attention, impulsivity and motor activity. of attention, impulsivity and motor activity.

Other Causal Factors Other Causal Factors Environmental: Environmental:

1.Lead Exposure 1.Lead Exposure 2.Pregnancy/Delivery Complications 2.Pregnancy/Delivery Complications 3.Poor Maternal Health 3.Poor Maternal Health 4.Prematurity 4.Prematurity 5.Fetal Exposure to Maternal Alcohol 5.Fetal Exposure to Maternal Alcohol use use 6.Maternal 6.Maternal Smoking Smoking 7.Head Injury7.Head Injury

Psycho-Social: Psycho-Social: 1.Emotional Trauma (Violence and 1.Emotional Trauma (Violence and

Abuse) Abuse) 2.Low Social Class 2.Low Social Class 3.Family 3.Family Dysfunctions Dysfunctions 4.Chronic 4.Chronic Conflict Conflict 5.Exposure To 5.Exposure To Parental Parental Psychopathology and Depression Psychopathology and Depression (Especially Maternal) (Especially Maternal)

DiagnosisDiagnosisBy A By A TrainedTrained Healthcare Provider Healthcare Provider

Based on A Comprehensive Physical Based on A Comprehensive Physical Exam And A Thorough Review of the Exam And A Thorough Review of the Child’s Medical, Psychosocial, and Family Child’s Medical, Psychosocial, and Family HistoryHistory

Six or more of the following symptoms of Six or more of the following symptoms of inattentioninattention must be present for at least must be present for at least six months to a point that is six months to a point that is disruptive/inappropriate for developmental disruptive/inappropriate for developmental levellevel::

Does not give close attention to details or makes Does not give close attention to details or makes careless mistakes in schoolwork, work, or other careless mistakes in schoolwork, work, or other activitiesactivities

Has trouble keeping attention on tasks or play Has trouble keeping attention on tasks or play activitiesactivities

Does not seem to listen when spoken to directlyDoes not seem to listen when spoken to directly Often does not follow instructions and fails to finish Often does not follow instructions and fails to finish

chores, schoolwork, or duties in the workplacechores, schoolwork, or duties in the workplace Has trouble organizing activitiesHas trouble organizing activities Avoids, dislikes, or doesn’t want to do things that take Avoids, dislikes, or doesn’t want to do things that take

a lot of mental effort for a long period of timea lot of mental effort for a long period of time Loses things needed for tasks Loses things needed for tasks Easily distractedEasily distracted Forgetful on a daily basisForgetful on a daily basis

Six or more of the following symptoms of Six or more of the following symptoms of hyperactivity-impulsivity hyperactivity-impulsivity must be present must be present for at least six months: for at least six months:

Fidgets with hands/feet or squirms in seatFidgets with hands/feet or squirms in seat Gets up from seat unexpectedly Gets up from seat unexpectedly Runs about or climbs when and where it is not Runs about or climbs when and where it is not

appropriateappropriate Has trouble playing Has trouble playing quietlyquietly Moves excessively Moves excessively Talks excessively Talks excessively Blurts out answers too soonBlurts out answers too soon Has trouble waiting one’s turnHas trouble waiting one’s turn Interrupts/intrudes on othersInterrupts/intrudes on others

Psychometric tests most widely used in the Psychometric tests most widely used in the diagnosis of ADHD include the following: diagnosis of ADHD include the following:

The Conners' Parent and Teacher Rating Scale The Conners' Parent and Teacher Rating Scale (for children) and the Brown Attention Deficit (for children) and the Brown Attention Deficit Disorder Scale (BADDS) for Disorder Scale (BADDS) for teensteens and adults and adults may be useful in arriving at a diagnosis.may be useful in arriving at a diagnosis.

Impulsivity and inattention can be assessed Impulsivity and inattention can be assessed with timed computer tests, such as the Conners with timed computer tests, such as the Conners Continuous Performance Test (CPT), the Continuous Performance Test (CPT), the Integrated Visual and Auditory (IVA) CPT, or Integrated Visual and Auditory (IVA) CPT, or both.both.

The Nadeau/Quinn/Littman ADHD Self-Rating The Nadeau/Quinn/Littman ADHD Self-Rating Scale for Girls should be part of the Scale for Girls should be part of the assessment for all girls.assessment for all girls.

Various neuropsychiatric tests can be used to Various neuropsychiatric tests can be used to identify strengths and weaknesses in executive identify strengths and weaknesses in executive function.function.

Evaluation of intellectual function (for example, Evaluation of intellectual function (for example, intelligence quotient, or IQ) can be helpful in intelligence quotient, or IQ) can be helpful in distinguishing between ADHD and intellectual distinguishing between ADHD and intellectual impairment. impairment.

Assessment of ADHD In SchoolAssessment of ADHD In School

Peer rating scalesPeer rating scales- Tool used to show the - Tool used to show the teachers’ and peers’ perceptions of the teachers’ and peers’ perceptions of the students’ academic and social behaviorstudents’ academic and social behavior

Direct ObservationDirect Observation- Careful daily record-- Careful daily record-keeping of academic performance and keeping of academic performance and behaviors in various school settingsbehaviors in various school settings

TreatmentTreatment

Instructional ImplicationsInstructional Implications

MedicationMedication

The main treatment for ADHD has been The main treatment for ADHD has been use of prescribed stimulant drugs, which use of prescribed stimulant drugs, which are believed to enhance are believed to enhance neurotransmission of dopamine and neurotransmission of dopamine and norepinephrinenorepinephrine

Behavior InterventionsBehavior Interventions

Rewards and response costs are used to change behavior - Rewards and response costs are used to change behavior - after examining problem behavior, understanding antecedents after examining problem behavior, understanding antecedents and consequencesand consequences

Reward oftenReward often

Self-Regulation: methods students use to helpSelf-Regulation: methods students use to help make a make a conscious, immediate assessment past behavior and plan to conscious, immediate assessment past behavior and plan to change future behavior, if necessary.change future behavior, if necessary.

Self-Management: requires students to self-assess and self-Self-Management: requires students to self-assess and self-

record a behavior at set or cued intervals. The student’s record a behavior at set or cued intervals. The student’s evaluation must match an observer’s observation to receive evaluation must match an observer’s observation to receive token reinforcement token reinforcement

Instructional InterventionsInstructional Interventions

Self-instructionSelf-instruction involves teaching students to talk involves teaching students to talk to themselves about what they to themselves about what they areare doing and doing and what they what they should beshould be doing doing

Self-Monitoring Self-Monitoring involves cueing the student so involves cueing the student so he/she can note whether he/she was on or off he/she can note whether he/she was on or off task-using a simple recording sheet.task-using a simple recording sheet.

Mnemonic StrategiesMnemonic Strategies are ways of helping are ways of helping students remember thingsstudents remember things

Instructional Interventions Instructional Interventions (suggestions) (suggestions)

Materials should be available and accessible-Kept in a Materials should be available and accessible-Kept in a designated place when not in usedesignated place when not in use

Use graphic organizers during instructionUse graphic organizers during instruction Use visualsUse visuals Use manipulativesUse manipulatives Use computer softwareUse computer software Use mediaUse media Allow peer tutoring and cooperative learningAllow peer tutoring and cooperative learning

Instructional InterventionsInstructional Interventions

Use notebook or folder for daily Use notebook or folder for daily communication with parentscommunication with parents

Make directions clear and conciseMake directions clear and concise Be consistent Be consistent Seat student within close proximity to Seat student within close proximity to

teacherteacher

Mnemonic strategiesMnemonic strategies Help students remember thingsHelp students remember things Use first letter strategiesUse first letter strategies Examples:Examples:

Planets In Order - Planets In Order - MMy y VVery ery EEasy asy MMethod ethod JJust ust SSpeeds peeds UUp p NNaming aming PPlanets: Mercury, Venus, Earth, Mars, Jupiter, lanets: Mercury, Venus, Earth, Mars, Jupiter, Saturn, Uranus, Neptune, PlutoSaturn, Uranus, Neptune, Pluto

Colors of the Rainbow: ROY G BIV -Colors of the Rainbow: ROY G BIV -Red Orange Yellow Green Blue Indigo Red Orange Yellow Green Blue Indigo

VioletViolet

ConclusionConclusion

ADHD cannot be cured but ADHD cannot be cured but cancan be be managed via a combination of the correct managed via a combination of the correct dosage of appropriate medications and the dosage of appropriate medications and the use of cognitive/behavior interventionsuse of cognitive/behavior interventions