Adhd handbook11
- 2. IndexIndex What is ADHD?............................................ 3What is ADHD?............................................ 3 How do I know if I have ADHD?.................. 6How do I know if I have ADHD?.................. 6 What Causes ADHD?................................... 7What Causes ADHD?................................... 7 Medication……………………………………………11Medication……………………………………………11 Divorce & ADHD…………………………………….14Divorce & ADHD…………………………………….14 IQ & ADHD…………………………………………….16IQ & ADHD…………………………………………….16 Myths…….…………………………………………….18Myths…….…………………………………………….18 Strategies…………………………………………... 22Strategies…………………………………………... 22 Summary……………………………………………..25Summary……………………………………………..25
- 3. WHAT IS ADHD? Attention Deficit Disorder is commonly referred to as ADHD. Three types of ADHD are identified by the National Institute of Mental health. They are: the predominantly hyperactive-impulsive type (that does not show significant inat- tention); the predominantly inattentive type (that does not show significant hy- peractive-impulsive behavior) sometimes called ADD; and the combined type (that displays both inattentive and hyperactive-impulsive symptoms). Professionals often use the one abbreviation, ADHD, to refer to all 3 types of at- tention problems listed above. This commonly causes confusion among parents. Compounding this confusion is that ADHD can sometimes include other symp- toms like oppositional behavior, low self-esteem, emotional outbursts, and oth- ers. Other disorders may exist with ADHD. These are called co-morbidities. Al- though it sounds terrible, it just means that you may have two problems at the same time. It is believed that ADHD begins in childhood—generally in preschool and early school years. These children find it difficult to control their behavior and/or pay attention. It is estimated that between 5 and 7 percent of children have ADHD, or approximately 2 million children in the United States. This means that in a class- room of 25 to 30 children, it is likely that at least one will have ADHD.
- 4. WHAT IS ADHD? (Cont.) No pathology exists for ADHD; that is to say that although ADHD is considered a neurological (brain based) disorder, currently no one can find a location in the brain where it exists. For example, if someone had a tumor, a surgeon could find it and remove it. ADHD doesn’t exist in that sense. It is typically diagnosed using a series of characteristics or a checklist. ADHD affects both children and adults. It is characterized by symptoms of inat- tention, impulsivity, and sometimes, hyperactivity. The ratio of ADHD boys to girls treated in clinical settings is typically 4:1. Girls are often overlooked as they do not frequently display hyperactivity or behavioral problems. Studies indicate that women possibly are affected more in adulthood than are their male counterparts. The label, attention-deficit/hyperactivity disorder, is a misnomer of sorts. People with the disorder do not have a deficit or lack of attention, but they do have dif- fused attention—attention that is fleeting and can be sustained only for short pe- riods before moving on. Often accompanying inattention are such problems as frequent distractibility,
- 5. WHAT IS ADHD? (Cont.) difficultly being organized, keeping track of things, making careless mistakes, and failing to complete tasks, etc. Hyperactivity is often characterized by excessive talking, constant fidgeting, or constantly being on the go as if driven by a motor. Since most everyone exhibits these characteristics periodically, an ADHD diag- nosis is dependent upon the frequency that the characteristics are exhibited. ADHD can be easily mistaken for other problems like learning disabilities, uni- dentified mood disorders or parenting problems. Conservatively, about 65% to 70% of all children will carry their symptoms into adulthood.
- 6. HOW DO I KNOW IF I HAVE ADHD? A diagnosis can be made by a qualified pro- fessional using a variety of tests including computerized tests of attention, parent and teacher behavioral checklists, interviews of parent and child, and other tests. It is im- portant to take two to three hours to get a thorough diagnosis from a qualified profes- sional. Many professionals who specialize in ADHD are listed on the Internet or in the phone book. Since no physical location exists in the brain, the diagnosis is always subjective. Have the professional explain the assess- ments to you in a manner you can under- stand. ADHD is commonly treated with medication often supplemented by cognitive skill sup- port and behavior shaping programs.
- 7. WHAT CAUSES ADHD? Currently, the cause of ADHD is a mystery. Although ADHD is considered a brain disorder, according to the National Insti- tutes of Health, no certain brain abnormality exists that definitively establishes the presence or absence of ADHD. ADHD has no biological marker, no place in the brain that clearly marks its loca- tion, and so it is not identifiable as to physical location or magnitude. Current re- search indicates that it may be caused by a variety of factors. It is often challenging even for experienced professionals to accurately diagnose ADHD since it is often confused with learning disorders, low self-esteem, or op- positional behaviors. Using brain scans, researchers have reported structural and functional brain dif- ferences between subjects considered normal and those considered having ADHD. Scanning and techniques like brainwave mapping or QEEG are currently considered new technologies that need more investigation. They rely on the no- tion that dysregulated brainwaves cause attention problems or ADHD. This is only one of many theories.
- 8. WHAT CAUSES ADHD? (Cont.) Others theories include: • Developmental delays caused by smaller brain volume. • Environmental toxins. • Heredity. • Neurotransmitter malfunction (brain chemistry is not working). • Brain damage. Scientists have discovered that some children’s brains develop more slowly than other children. This results in a 3 year developmental delay on average. This is preliminary research and may account for only 20% of all children di- agnosed with ADHD. Further research will be necessary to prove this theory.
- 9. WHAT CAUSES ADHD? (Cont.) The British have performed significant studies regarding environmental toxins and their effects on the human brain. Many studies suggest that toxins such as lead, mercury, PCBs, etc. can produce ADHD-like symptoms. ADHD may be passed along in families genetically (heredity). Immediate family members seem to be more vulnerable to ADHD. For example, if one identical twin possesses ADHD, there is a 93% probability that its twin will possess it too. If one parent has ADHD, there is a 25% chance that he or she may produce a child with ADHD. Although a few studies on ADHD and heredity have been completed, data regarding heredity and ADHD are primarily based on observation. Further long term evaluation seems to be necessary as conflicting data have been produced in various studies regarding ADHD and specific genes. Some scientists speculate that the brain’s chemistry does not work correctly resulting in poor attention.
- 10. WHAT CAUSES ADHD? (Cont.) The brain is composed of cells that communicate to one and other by firing chemicals (neurotransmitters) to each other. Some scientists speculate that im- proper reception or transmission of certain brain chemicals may cause ADHD. Some scientists believe that certain areas of the brain do not work correctly in individuals who have ADHD. A search on the Internet will provide many studies that indicate various parts of the brain are dysfunctional (damaged or not working properly) in ADHD persons. No one truly knows what causes ADHD. It may be a normal trait passed on in family mem- bers as readily as hair color, crooked teeth, or freckles. It may be caused by a variety of factors. Until we under- stand more about the vast differences in the spectrum of human traits and how these are affected by our environ- ment, the cause of ADHD will remain a mystery.
- 11. MEDICATION Currently, medication is the primary treatment for ADHD. Most types of ADHD respond well to stimulant medications. The actual way that medication works is not well understood. Medication does not cure ADHD. It masks the symptoms enabling better focus and concentration. Medication has been researched for about 60 years. Many parents fear medicating their child long-term. This may be based emotionally or on fact. It is important to remember that medication is given by healthcare pro- viders to benefit your child, not to placate our teachers, parents, coaches, or anyone else. According to the Multimodal Treatment of ADHD Children (MTA), one of the longest studies done regarding medication, decreased height and weight were common in children on medication. Other side-effects are commonly reported in- cluding decreased appetite, sleep problems, and tics (involuntary twitches). Medication is not a targeted approach to treat ADHD. In fact, low-dose stimulant medication works similarly for both ADHD and non-ADHD children. For example, given a child with ADHD and a very focused child without ADHD, both given a boring task, both given low-dose stimulant medication, both will perform better.
- 12. MEDICATION (Cont.) This is related to the common misconception that medication ‘calms’ a hyperac- tive child. We’d expect stimulant medication to make him more hyperactive. In fact, medication does not calm a hyperactive child. Instead, it enables the child to be able to focus on boring tasks and to become more methodical making the child appear calmer. Low doses of stimulant medication produce the same reac- tion in ADHD children and non-ADHD children. Given this fact, it’s important to get a thorough evaluation from an ADHD spe- cialist. Commonly, children visit their pediatrician for twenty minutes or so and walk out with medication. A reverse diagnosis has been made; the doctor may think it’s ADHD and prescribes medication to see if it works. If the medication works, then it was ADHD! But, if we know that low-dose stimulant medication works for everyone, we really don’t know if it’s truly ADHD. Dr. William Pelham, one of the authors of the MTA tells us: "I think that we exaggerated the beneficial impact of medication in the first study. We had thought that children medicated longer would have better outcomes. That didn’t happen to be the case. There’s no indication that medication’s better than nothing in the long run." Dr. Pelham states this because the MTA could identify no differences between
- 13. MEDICATION (Cont.) children who did not take medication and those children that did for 3 years. This seems to be verified by a variety of studies. The results of which include: • No long term changes in global academic performance. • No long term changes in social conduct. • No long term changes demonstrating improved behavior. Obviously, medication can play a positive role in some circumstances, but un- derstanding that it teaches nothing, has limited effects, and does not provide long term improvement academically, socially, or behaviorally, should tell us we have to provide more than just medication alone. Most specialists now agree that a multimodal approach should be undertaken. Other strategies include behavioral shaping, cognitive training, counseling, study skills, etc. So, instead of considering only short-term stop-gap measures, we must take into account the biological, psychological, social, and academic ele- ments to provide a lifetime of happiness and success at school and the work- place.
- 14. DIVORCE & ADHD When it involves ADHD, psychologist William Pelham is one of the most prolific researchers around. Pelham and his col- league Dr. Brain Wymbs published a longitudinally study (Journal of Consulting and Clinical Psychology. Vol 76(5), Oct 2008, 735-744.) that tracked 282 families with and 206 without ADHD children. "We have known for a long time that kids can be stressful for their parents. What we show is they can be really stressful and can lead to marital dissatisfaction and divorce," said Pelham, who works at the State University of New York at Buffalo. "What it means is ADHD should not be treated without involving the par- ents in the treatment." Continued on next page They found that couples who have a child diagnosed as ADHD are almost twice as likely to divorce or become estranged compared to couples without an ADHD child. A simple dynamic is causal: ADHD children can be stressful for parents thus magnifying conflicts between spouses. ADHD children also have opposi- tional behaviors which increase stress at home.
- 15. DIVORCE AND ADHD CONT. The researchers found that parents with ADHD children tended to reach the point of divorce or separation faster than their peers. Parents of ADHD children are distinctly aware that battles over homework, chores, discipline are key stressors that provide further conflict between spouses. It is understandable that 22.7 percent for parents of kids with ADHD were divorced by the time the chil- dren were 8 years old as opposed to only 12.6 percent of the parents of non- ADHD children. "Parents of children with ADHD report less marital satisfaction, fight more often, and use fewer positive and more negative verbalizations during child-rearing dis- cussions than do parents of children without ADHD especially if the child also has conduct or oppositional problems," Pelham and Wymbs noted in their paper. The researchers discovered that regardless of whether parents had manageable or difficult children, if parents had an ADHD child they were three times as likely to be negative toward each other as parents who did not. Stress was up and pa- tience was thin. Does medicine help? Medicines can alleviate ADHD symptoms, however the re- searchers found that most meds were given in the daytime to improve school performance and wore off by evening when the children were to do homework.
- 16. IQ & ADHD In the Journal of Attention Disorders, Yale re- searchers studied whether high IQ might offset ADHD tendencies. The researchers found that having keen intelligence is no defense against the effects of ADHD. The researchers examined 157 ADHD adults with IQs equal to or greater than 120 (the top 9 percent of our society). The research tested the participant’s executive functions. Executive functions include the ability to attend, memory, organization, control of impulsivity, planning and decision making, etc. About 75% of the study’s participants demonstrated significant impairments in memory and cognitive tests compared to people without ADHD with similar IQ's. "Each of these individuals might be compared to a symphony orchestra of very talented musicians who cannot produce adequate symphonic music because the orchestra lacks an effective conductor," the authors wrote. Continued on next page
- 17. IQ & ADHD continued "Many of these people are told they can't be suffering the loss of executive func- tion (the ability to plan and carry out many day-to-day tasks) from ADHD be- cause they are too smart,'' said Thomas E. Brown, assistant professor of psy- chiatry at the Yale School of Medicine and lead author of the study. Therefore the researchers concluded that having superior intelligence did not fend off the problems that accompany ADHD. High IQ did not prevent forgetful- ness or procrastination, or the ability to pay attention in daily tasks at work and home.
- 18. ADHD MYTHS Maturation It is a myth that one matures out of or out grows ADHD. Conservative estimates predict that approximately 60% to 70% of children with ADHD will carry their symptoms into adulthood and can be diagnosed in adults. It is speculated that the remaining 30% acquire compensatory skills. Therefore ADHD doesn’t neces- sarily diminish as one grows older. It seems that adult ADHD begins in childhood and persists into adulthood. Concentration and impulsive difficulties often persist into adolescence, causing significant difficulties. Instead of being hyperactive, teachers may notice rest- lessness, inattentiveness, or excessive talking. As adults, symptoms of ADHD, such as inattention, impulsivity, and hyperactivity often affect performance in the work place. Employers often complain ADHD adults cannot follow through with instructions, often talk out of turn, or fail to complete tasks. Research conducted by Harvard University found that ADHD adults with a
- 19. ADHD MYTHS (Cont.) university degree have annual household incomes approximately $4000 less than their peers without the disorder. The study also found that ADHD adults with high school diplomas had household incomes averaging $11,000 less than their peers without the disorder. The study showed that adults with ADHD were less likely to have a full-time job and had a job turnover rate that was twice as high over the last 10 years com- pared with those without ADHD. Researchers also concluded that adult ADHD may make it more difficult to get education necessary to obtain high-paying jobs. Other research has also indicated ADHD adults had higher divorce rates and were more likely abuse alcohol or drugs. Further research suggests that ADHD adults have higher rates of traffic accidents and were less likely to have a posi- tive self-image or be optimistic. Overall, ADHD adults reported lower levels of satisfaction with all aspects of their lives including their marriages and social re- lationships. Video Games It is a myth that video games or TV cause ADHD. Not all video games are cre- ated equally. Some video games require thinking skills and are therefore re-
- 20. ADHD MYTHS (Cont.) garded as educational. However, the most popular video games incorporate fast-paced, point & shoot action. Several studies have shown that these games, while increasing visual perception, often diminish activity in the frontal lobes of the brain where executive functions are controlled. Executive functions include attention, controlling impulsivity, and controlling aggression. As a parent, it’s important to understand what type of games your child is play- ing. It is also a good idea to limit fast-paced video game play for your ADHD child. You may opt to use video game play as a reward. Exercise is always bet- ter whether it’s going for a walk, going to dance class, or going to a martial arts class. Parenting Poor parenting does not cause ADHD. However, poor parenting can definitely make parenting an ADHD child much more difficult and stressful. Setting a consistent structure to your home environment is often a difficult but re- warding task. Structure means establishing times for every household activity be it getting up in the morning, brushing teeth, homework time, dinner time, or bed time.
- 21. ADHD MYTHS (Cont.) Providing a rewards program that carefully coincides with a consistent program of rules and consequences can help effectively manage your ADHD child. Play Attention staff can assist you with setting up a structured environment at home. Girls Have Lower Rates of ADHD than Boys Boys are often clinically diagnosed for ADHD 4:1 over girls. Although girls are di- agnosed for ADHD far less than boys, research has shown that girls with ADHD have greater cognitive impairment. It is speculated that girls exhibit lower rates of hyperactivity and externalize behaviors far less than boys. So while they are diagnosed with ADHD less than boys, it is possible that as many girls with ADHD exist as boys. Many studies currently indicate that girls also present greater problems later in life because they fail to get properly diagnosed. The problems include eating dis- orders, substance abuse, job loss, etc.
- 22. STRATEGIES While medication may be an important part of an ADHD intervention, it should not be considered an end in itself. The best chances of success will come from initiating a program that addresses all the issues your child, spouse, or client may present. Physical Interventions Physical exercise is essential. It helps us direct and release excess energy. Many studies show that just being outside for a period of time during our day can reduce ADHD symptoms. Classes in dance or martial arts help us coordinate and focus our minds and bodies. They are usually very helpful for both children and adults. We meet peo- ple like ourselves there; people that must express themselves through move- ment, can’t sit still, or have a common interest. Consistent exercise will not cure ADHD, but it certainly will assist you to becoming more balanced and offer greater mental function. Even doing as little as walking every day can produce results as the brain tends to release chemicals for growth based on stimulation.
- 23. STRATEGIES (Cont.) Nutrition While better nutrition will not cure ADHD, it can set you on a road to better health both mentally and physically. Doing away with consumption of greasy fast-foods, chips, and snacks containing many food additives may help. The British have performed many studies examining the effects of omega-3 fatty acids (fish oil), zinc, and other nutrients. They’ve experienced positive results with some people in the reduction of ADHD symptoms. Whether this will work for you is really trial and error. It is an inexpensive way to possibly improve atten- tion. Food coloring is also a subject of debate as some researchers have found that certain food dyes seem to cause either hyperactivity or decreased attention. The jury is still out on this, but it’s not a bad idea to restrict your intake of highly col- ored processed foods. Counseling & Coaching Counseling can play an important role. Counselors and coaches can provide strategies for you or your family. They also can assist you with setting structure in your life, setting goals, and achieving them.
- 24. STRATEGIES (Cont.) Cognitive skills We know that ADHD doesn’t exist alone. It is usually accompanied by cognitive problems like being un- able to finish tasks or filter out distractions. We may not be organized or able to process multiple-step di- rections. Without these cognitive skills, homework or office work becomes drudgery. Play Attention was developed to assist you in attaining these skills and more. Play Attention also involves coaching to set goals and reach them. Behavior shaping It’s been demonstrated repeatedly in study after study that setting a structured environment with rules and consequences followed consistently produces good results for ADHD people. This is perhaps one of the most difficult aspects of fam- ily life; it is very difficult to remain calm and collected while reinforcing conse- quences. Fortunately, this is part of the Play Attention program. Our specialists help you set structure and provide positive reinforcement for success.
- 25. SUMMARY No matter what strategies you employ, it’s important to have a system in place to determine if anything good is happening. Start by setting goals. Goals should always be reachable. Remember small steps lead to big successes. Have a method in place to chart whether you reach your goals. Goals can be simple like bringing home homework for two days consecutively. They can also be assessed by teachers, coaches, parents, and others using a simple checklist. This provides a means by which both the ADHD person and caregiver can see if things are getting accomplished. Success is the greatest motivator. We only get super successes through super consis- tency. www.playattention.com 800.788.6786