lynn nelson eex 5051 university of central florida june 2009 nelson adhd eex5051 ucf 09

Lynn NelsonEEX 5051

University of Central FloridaJune 2009

Nelson ADHD EEX5051 UCF 09

The Story of Fidgety Phil Poem

credited as being the earliest literary reference to ADHDLet me see if Phillip can, be a little gentleman.

Let me see, if he is able, to sit for once at table; Thus Papa bade Phil behave; and Mamma look’d very grave.

But fidgety Phil, He won’t sit still; he wiggles and giggles,

And then, I declare Swings backwards and forwards and tilts up his chair,

Just like any rocking horse; “Phillip I am getting cross!”

-Heinrich Hoffmann 1865

Source: Hallahan, Kuffman, & Pullen (2009), Chapter 7, Learners with Attention Deficit Hyperactivity Disorder, Exceptional Learners, An Introduction to Education, Ed.11, (pg 223), Boston; Allyn and Bacon.


History

1865: Physician Heinrich Hoffman’s Fidgety Phil poem. Followed later with poem called “Johnny Head-in-the-Air”

1902: Royal College of Physicians of London, Dr George F. Still delivered three lectures concerning children he referred to as having “defective moral control”.



Psychological HistoryGoldstein’s Brain Injured Soldiers of WW I: 1936; Kurt Goldstein;

developed preservation model: tendency to repeat same behaviors &“forced responsiveness to stimuli” Ground distraction.

The Strauss Syndrome: late 1930’s early 1940’s; Heinz Werner & Alfred Strauss; distractibility.

Cruickshank’s Work: 1950’s; “minimally brain injured” criteria for those whom meet today’s criteria for ADHD.

Minimal Brain Injury: 1950’s: Brain pathology oriented.

Hyperactive Child Syndrome:1960’s; marks a more definitive approach away from Brain oriented subtleties.

Source: Hallahan, Kuffman, & Pullen (2009), Chapter 7, Learners with Attention Deficit Hyperactivity Disorder, Exceptional Learners, An Introduction to Education, Ed.11, (pp 226-227), Boston; Allyn and Bacon.


Defining ADHD

Definition: ADHD:

Attention deficit hyperactivity disorder:

A condition characterized by severe problems of inattention, hyperactivity, and/or impulsivity; often found in people with learning disabilities.

Source: Hallahan, Kuffman, & Pullen (2009), Glossary, Exceptional Learners, An Introduction to Education, Ed.11, (pg 565), Boston; Allyn and Bacon.


DEFINITION

Attention-deficit/hyperactivity disorder (AD/HD or ADHD) is a neurobehavioral developmental disorder.

It is the most commonly diagnosed psychiatric disorder in children affecting about 3 to 5% of children globally with symptoms starting before seven years of age.

It is characterized by a persistent pattern of impulsiveness and inattention, with or without a component of hyperactivity.

ADHD is diagnosed twice as frequently in boys as in girls, though studies suggest this discrepancy may be due to subjective bias.

SOURCE: http://en.wikipedia.org/wiki/Attention-deficit_hyperactivity_disorder


DEFINITION cont’d.

ADHD is generally a chronic disorder with 30 to 50% of those individuals diagnosed in childhood continuing to have symptoms into adulthood

As they mature, adolescents and adults with ADHD are likely to develop coping mechanisms to compensate for their impairment

SOURCE: http://en.wikipedia.org/wiki/Attention deficit_hyperactivity_disorder


http://en.wikipedia.org/wiki/Attention

SIGNS & SYMPTOMS

Common ADHD symptoms include inattentive, hyperactive, and impulsive

behavior

ADHD symptoms can affect children all day and every day

ADHD can affect a child's ability to focus, sit still, and follow instructions

The symptoms of ADHD can also affect a child's social interactions with others


What Causes ADHD

http://video.about.com/add/ADHD.htm

The Brain –

Frontal Cortex – An interconnected combination of nerve cells believed responsible for ATTENTION

Neurons- Neurotransmitters & Neuroreceptors communicate through chemical reactions conducted over synapse

Chemical transmitter Dopamine regulates Behavior

This model follows and example that indicates that there is a genetic deficiency of some neurotransmitters




ADHD Vocabulary

Disinhibition: The ability to repress thoughts or actions that may be socially inappropriate.

Inhibitory Responses: Activity in the brain that tells us what is appropriate to think and say “THINK IT BUT DON’T SAY IT!”

ON THE MIND—OUT THE MOUTH

Impulsivity: “if I can’t do it right I’ll do it fast”

Consequential Thought

Source: LaVoie, Richard; Developer/Presenter, Gunther, Noel; Producer, Camp, Joseph; Director (1994), Last One Picked, First One Picked On, video, United States, Greater Washington Educational Television Association


The Casual Theories ADHD

Myths

Sugar: Hyperactivity associated to environment.

Video Games: Unproven in research studies. Perhaps more effective way of controlling behavior.

Artificial Food Colorings and Diet: Unsubstantiated results generated though “blind” testing.



Hereditary and Environmental Factors

Family Studies: ADHD being passed along percentages Parent to child 57% Sibling risk is about 32%

Twin Studies: Indicate that generally more common in identical twins than fraternal twins.

Molecular Genetic Studies: Unlikely that a single gene is responsible for ADHD, but more likely a combination of several genes.

Toxins and Medical Factors: Evidence does show relationship between toxins and birth defects.

Source: Hallahan, Kuffman, & Pullen (2009), Chapter 7, Learners with Attention Deficit Hyperactivity Disorder, Exceptional Learners, An I introduction to Education, Ed.11, (pp 235-236), Boston; Allyn and Bacon.


Is there a treatment?

Parents need to be proactive about how to effectively manage their child's ADHD symptoms

Once ADHD is diagnosed it is generally the child’s pediatrician that will institute a tailor made individual treatment plan

Many Doctors use ‘stimulant drugs’ as the most commonly prescribed medication to treat ADHD

Stimulants have a calming effect on children with ADHD


Treatment cont’d.

Schools may have have their nurses dispense ADHD medication that is prescribed by a students pediatrician, once a copy of the original prescription is kept on file

Information about the students ADHD medication is also listed in the child’s IEP and this record is kept confidential


What ADHD is and is not…………

ADHD is not a reflection of a child’s intelligence or the result of poor parenting skills

It is a condition of the brain that makes it difficult for children to focus, pay attention, and control their behavior

ADHD is a real and treatable medical condition and it is estimated that it affects over 5 million children in the United States alone


Stimulants and Sudden Death

“A study examining stimulant use among children and adolescents found an association between stimulants and sudden unexplained death in youth with no evidence of pre-existing heart disease.”

Attention must be paid the the fact that although the potential risk of exposing children to stimulant medications sudden death may be a rare occurrence but it does occur.

Source: http://www.nimh.nih.gov/science-news/2009/questions-raised-about-stimulants-and-sudden-death.shtml


Cost benefit analysis

The results of the study draw attention to concerns that stimulant medications increase the risk of sudden unexplained death in children and adolescents

According to an editorial, by coauthors Benedetto Vitiello, M.D. and Kenneth Towbin, M.D., both at NIMH, they point out that the study they conducted on stimulant medications and sudden death occurrences, could not provide information on whether ADHD itself could increase the risk of sudden death, or its association with high-risk behaviors such as substance abuse

Vitiello, B. and Towbin, K. Stimulant treatment of ADHD and risk of sudden death in children. Retrieved June 19, 2009 from American Journal of Psychiatry AIA:1-10, 2009.


Benefit vs. Risk Assessment

“The editorial went on to note that while randomized prospective studies are not practical—given the large numbers of subjects needed to detect such rare events—additional case/control studies would still be informative. In addition, research to improve screening methods for heart conditions that raise the risk of sudden death is essential.”

Gould, M.S., Walsh, T., Munfakh, J.L., Kleinman, M., Duan, N., Olfson, M., Greenhill, L, and Cooper, T. Sudden death and use of stimulant medications in youth. Retrieved June 18, 2009, from American Journal of Psychiatry AIA:1-10, 2009


FINDINGS

The editorial notes the following

"1) sudden unexplained death is a rare event

2) this is only the first such study

3) it relies on small numbers

4) it is not possible to quantify the risk beyond estimating that it is very small.”

Source: Gould, M.S., Walsh, T., Munfakh, J.L., Kleinman, M., Duan, N., Olfson, M., Greenhill, L, and Cooper, T. Sudden death and use of stimulant medications in youth. Retrieved June 18, 2009, from American Journal of Psychiatry AIA:1-10, 2009


Special Education and ADHD

Section 504 of the Rehabilitation Act of 1973 and the Individuals with Disabilities Education Act (IDEA) are laws that have been enacted to ensure that children with disabilities, including ADHD, receive an appropriate education

www.chadd.org


Is there a cure for ADHD?

Currently there is no cure for ADHD

Brain research is ongoing to learn more about the role of the brain in the cause of ADHD

Symptoms of ADHD can be effectively managed with treatment regimens

ADHD continues into adolescence and adulthood in many cases

Approximately 80 percent of children who need medication for ADHD may still need it as teenagers

Treatment programs that include medication and behavioral therapy can help a child manage their ADHD symptoms


How does ADHD manifest in a child’s daily life?

When a child displays a persistent pattern of inattention and hyperactive, impulsive behavior that occurs more frequently and more severely than other children of similar age, it is assumed their condition is caused by ADHD


ADHD Education and Support

The more information you know about ADHD, the better you are equipped to offer guidance to others who have questions

When school professionals understand how ADHD affects a student's life, they can play a key role in developing strategies to help children manage the everyday challenges they face


The Federal Mandate

United States Department of Education –Your child's rights under federal laws designed to ensure that children with disabilities, including ADHD, receive an appropriate education

Source: http://www.ed.gov/offices/OSERS/Policy/IDEA/index.html


ADHD Resources (for education and support)

American Medical Association (AMA) - This professional organization for doctors is dedicated to the art and science of medicine and promoting public health. http://www.ama-assn.org

CHADD.org - Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD) is a national nonprofit organization that provides advocacy and support for people with ADHD. www.chadd.org


ADHD Resources (for education and support) cont’d.

ADDitude Magazine - Stay on top of the latest information about ADHD in children, adolescents and adults. http://www.additudemag.com

The Mayo Clinic - The Mayo Clinic is dedicated to the diagnosis and treatment of virtually every type of complex illness, including ADHD. http://www.mayoclinic.com


ADHD Resources (for education and support) cont’d.

NIMH.NIH.gov - The National Institute of Mental Health provides useful information about ADHD in children, adolescents and adults. http://www.nimh.nih.gov

Learning Disabilities Association of America (LDA) - LDA is one of the largest non-profit volunteer organizations advocating for individuals with learning disabilities. http://www.ldanatl.org


REFERENCES

Hallahan, Kuffman, & Pullen (2009), Chapter 7, Learners with Attention Deficit Hyperactivity Disorder, Exceptional Learners, An Introduction to Education, Ed.11, (pp 223-257), Boston; Allyn and Bacon.

Cox DJ, Merkel RL, Moore M, Thorndike F, Muller C, Kovatchev B. Relative benefits of stimulant therapy with OROS methylphenidate versus mixed amphetamine salts extended release in improving the driving performance of adolescent drivers with attention-deficit/hyperactivity disorder. Retrieved June 18, 2009, from Pediatrics, 2006 Sept; 118(3):e704-e710.

http://en.wikipedia.org/wiki/Attention-deficit_hyperactivity_disorder. Retrieved June 17,2009, from Wikipedia

Linnet KM, Dalsgaard S, Obel C, Wisborg K, Henriksen TB, Rodriguez A, Kotimaa A, Moilanen I, Thomsen PH, Olsen J, Jarvelin MR. Maternal lifestyle factors in pregnancy risk of attention-deficit/hyperactivity disorder and associated behaviors: review of the current evidence. Retrieved June 18, 2009, from American Journal of Psychiatry, 2003 Jun; 160(6):1028-1040.


REFERENCES cont’d.

http://www.nimh.nih.gov/health/publications/nimh-publications.shtml. Retrieved June 17, 2009, from NIMH National Institute of Mental Health, 2009.

http://www.nimh.nih.gov/science-news/2009/questions-raised-about-stimulants-and-sudden-death.shtml. Retrieved June 17, 2009, from NIMH National Institute of Mental Health, 2009.

LaVoie, Richard; Developer/Presenter, Gunther, Noel; Producer, Camp, Joseph; Director (1994), Last One Picked, First One Picked On, video, United States, Greater Washington Educational Television Association


Comedian Steven Wright

on ADHD

"I was trying to daydream but my mind kept wandering.”


Classroom Exercise Links

http://quiz.healia.com/



lynn nelson eex 5051 university of central florida june 2009 nelson adhd eex5051 ucf 09

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