Attention Deficit Hyperactivity disorder

Document Sample
Attention Deficit Hyperactivity disorder Powered By Docstoc
					 Welcome to the world of

Where landing is learned in
   What do people think of when
          they hear “AD/HD?
 Not a real disorder
 Disorder   of childhood
 Over-diagnosed
 Over medicated
 Due to poor parenting/ lack of discipline
 Boys have it more often than girls
 Ritalin is like cocaine and causes
 It is an excuse to not take responsibility for
 What are the characteristics of
 Lazy
 Stubborn
 Willful
 Braindamaged
 Disruptive
 Impossible
 Tyrannical
 Doesn’t live up to potential
 And…..just plain dumb
              What is AD/HD?

 AD/HD  is a disorder of attention and
  impulse control with specific DSM criteria.

 Itis defined by a set of 18 symptoms and
  to dx ADD, you must have at least 6.

 IT   is also known as:
      ADD
      Childhood hyperkinesis
  The common core features of
 Distractibility
     Poor sustained attention to tasks

 Impulsivity
     Impaired impulse control
     Impaired delay of gratification

 Hyperactivity
     Excessive activity and physical restlessness
 These       core features must be:
     Excessive
     Long-term
     Usually appear before the age of seven
     Last longer than six months
     Create a significant handicap in at least
      two areas of a person’s life:
       •   School
       •   Home
       •   Work
       •   Social settings
      How does this translate into
 Fails to pay close attention to details
 Makes careless mistakes
 Can’t stay on task
 Doesn’t seem to listen when spoken to
 Constantly losing or forgetting important
 Talks excessively
 Blurts out answers
 Difficulty awaiting their turn
   What is the difference between
         ADD and AD/HD?
 The  correct disorder is currently termed
 By current DSM-IV definition, ADD does
  not technically exist
 Rather, it is called AD/HD
     It is important to note that one can have
      AD/HD without having the “H”.
     This still falls under that AD/HD umbrella term
            Who gets AD/HD?

 Approximately      4-6% of the U.S. population
  has AD/HD
 Initially, it was thought that boys got
  AD/HD more often than girls
     However, it is now understood that gender
      differences changes how the disorder is
     Thus, girls are less likely to be referred for a
      diagnosis because they often do not fit the
      “stereotype” of AD/HD
What is the etiology of AD/HD?

      are currently several public
 There
 misconceptions about the cause of AD/HD
     Due to Food allergies
     Excessive sugar intake
     Brain injury
     Poor parenting
     Poor schools
     Family problems
What is the etiology of AD/HD?

 Ad/HD is now considered to be a
 neurobiological disorder.
     Heredity
       • This has the largest contribution to causing AD/HD
       • There is a 25-35% probability of it occurring in
         within a family
       • Compared to the 4-6% probability of it occurring in
         the general population.
            Etiology continued

 Thereare environmental risk factors that
 may increase the likelihood of AD/HD
     Difficulty during pregnancy
     Prenatal exposure to alcohol and tobacco
     Premature delivery
     Low birth weight
     Increased body lead levels
     Postnatal injury to the prefrontal regions of the
    Pathophysiology of AD/HD
   AD/HD has been shown to have problems in the
    catecholamine rich fronto-subcortical brain
      This is supported by the fact that stimulant

       medications are often effective.

   A 10 year NIMH study also showed that those
    with AD/HD has a 3-4% smaller brain than those
      They also demonstrated that this was not due

       to medication use.
         What does this mean?

 These areas of the brain that have been
 found to be affected by AD/HD are those
 that control the executive functions of life.

     Organization
     Activation of other brain regions
     Focusing
     Integrating information
     Allowing the brain to do routine and creative
Executive functions of the brain

 Working memory         and recall
     Holding facts in mind while manipulating
     Accessing facts stored in long term memory

 Activation,   arousal and Effort
     Getting started
     Paying attention
     Completing work
   Emotional control
      Tolerating frustration

      Thinking before acting or speaking

 Internalizing language
    Using self-talk to control one’s behavior and

     direct future actions
 Complex problem solving
    Taking an issue apart

    Analyzing the pieces

    Reconstructing and organizing them into new

        The types of AD/HD
 The   classic division of AD/HD was”
     Predominantly Inattentive type
     Predominantly hyperactive-impulse type
     Combined type
          A new Classification

 There is now a greater breakdown into six
    subclasses of AD/HD:
   Combined type
   Inattentive type
   Cingulate System Hyperactivity
   Limbic System Hyperactivity
   Basal ganglia hyperactivity
   Temporal lobe system dysfunction
          The Combined Type

 The Stereotype
 Identified early in life
 More often diagnosed in boys
 Low dopamine levels in the basal ganglia
  leads to:
     Decreased activity in the prefrontal cortex and
      premotor cortex
Review of brain structures
 Nutritional    help for combined type:
     High protein, Low carbohydrate diet
     Why?
       • This type of diet has a stabilizing effect on
         blood sugar levels
       • Refined carbohydrates negatively impact
         dopamine levels in the brain

 This is where cultural/family problems
  has complicated ADHD
     More quick grab meals such as Pop tarts,
      frozen waffles, pancakes and even cereal
      leads to more refined carbs in the diet.
              Inattentive type

 The “couch potato”
 Later childhood / early adolescent onset
 Brighter the individual, the later the
  symptoms develop
 Often appear “hypoactive”
     Daydreaming
     Being bored
     Unmotivated and apathetic
     sluggish
    Inattentive type continued

 Most   of those with inattentive adhd are
  never diagnosed.
 It is due to decreased brain activity in the
  frontal lobes of the brain.
 The harder the person tries to concentrate,
  the worse the ADHD gets.
 This type of ADHD also benefits from the
  high protein, low carb and low fat diets.
    Cingulate System Hyperactivity
   The “hyper focuser”
   This type has been found to have an increase in
    blood flow to the top and middle portions of the
    frontal lobe.
   This is the part of the brain that allows you to
    shift your attention from thing to thing
   Can present in many ways:
       Obsessions
       Compulsions
       Oppositional
   Stimulant medication makes this type of ADHD

   SSRI’s are commonly used because this subtype
    has been found to have lower levels of serotonin.

   This will often present as:
      Worrying

      Moodiness

      Emotional rigidity

      irritability
   Nutritional support for Cingulate system
      Carbohydrates

   Why?
     Carbs contain I-tryptophan

     This is an amino acid that is a building block

      for serotonin production

   A high protein, low carb diet makes this type
    worse because it contains larger amino acids
      These larger AA more successfully compete to

       getting into the brain.
Limbic System Hyperactivity
 The  limbic system is in the center of
  the brain
 It controls:
     emotional tone (how negative or
      positive you are)
     Motivation & drive
     Sleep and appetite cycles
     Bonding mechanism for connecting
 If   the limbic system is overactive:
      Clinical depression
      Bipolar disorder
      Severe PMS (PMDD)

 Nutritional   support
      Our limbic system needs fat to operate
      Recommended that patients increase their
       omega-3 fatty acid intake
      This is best form because increasing other
       fats can lead to other health problems that
       complicate the disorder.
 Basal Ganglia Hyperactivity
 The   basal ganglia integrates our
  feelings, thoughts and movements.
 It helps to shift and smooth our motor

 When    hyperactive:
     Anxiety
     Nervousness
     Panic Attacks
     Muscle tension
 Nutritional    support for basal ganglia
     Often associated with Hypoglycemia
       • Eat a well-balanced diet and often during the
       • Avoid high glycemic index foods
       • Eliminate caffeine (promotes anxiety)
       • Eliminate alcohol (withdrawal can induce

     Herbs such as Kava kava and valerian
      along with B6 have calming effects on the
      basal ganglia.
          Temporal Lobe Type

 Dysfunction    includes:
     Panic or fear for no reason
     Spaciness and confusion
     Dark thoughts
     Significant social withdrawal
     Déjà vu
     Irritability, rages
     Visual disturbances
      Temporal Lobe Dysfunction

 Temporal lobe problems may be inherited,
 however, this is the type that can be
 associated with brain trauma.

     nutritional support is purely
 Most
     A decrease in phosphatidal serine causes
      severe memory problems. Supplementation
      may be recommended.
               Brain imaging

Normal Brain                      ADHD brain
                  Image of ADHD
                                  on Adderall
The Picture on the Left is a PET scan of a Normal brain.
The Picture on the Right is a PET scan of an ADHD brain
 Gender differences and ADHD

      referred samples estimate that
 Clinic
  ADHD affect boys 10:1 over girls.

 Community   samples say that ratio is 2:1.

 However,    recent studies have
  demonstrated that girls express ADHD
  different than boys.
 Females        with ADHD:
     Fewer conduct problems than males
       • This is thought to be why females are not
         referred for evaluation as often.

     Tend to have more internalizing disorders
       • Females with ADHD compared to Females
         without ADHD show increased:
             Depression
             Anxiety
             Self-esteem disorders
             Episodes of self-injury
          Coexisting disorders

 Mood    disorders (25%)
     Depression
     Bipolar disorder

 Substance     abuse and addictions
     40% abuse alcohol
     20% abuse illicit drugs
     50% tobacco addiction
 Learning  disabilities (20%)
 Anxiety disorders
 Eating disorders
 Oppositional defiant disorder
    ADHD and eating disorders
 Compulsive overeating
    Eating temporarily increases our serotonin

    Short-lived, so must eat again to maintain

 Bulimia
    Binging and purging is a form of stimulation ,

     which is often craved in those with ADHD
 Anorexia
    Obsessing about weight and controlling one’s

     exercise and eating habits provides a
     mechanism to focus the brain on something
     and gives a sense of control.
 What’s it like to have ADHD?
 One    giant paradox.
     Superfocus and then space out when I least
     Project confidence and feel incredibly
     Perform at a very high level and feel
      incompetent while doing so.
     Time becomes mixed up
       • It seems that everything happens at once
       • Causes frustration and inner turmoil
       • Can’t prioritize
     It’s not all bad though…

 Creative   talents
 Original, out of the box thinking
 Remarkable persistence, resilience,
 Warm-hearted and generous behavior
 Highly intuitive
 Ability to multitask like no other.
 “The best way to think of ADD is not as a
  mental disorder but as a collection of traits
  and tendencies that define a way of being
  in the world.”
 There is some positive to it, and some
  negative to it.

   It is only when the negative becomes
    disabling that it becomes a disorder

   The ultimate goal of tx, is to turn the
    disability into an asset.
 ADD Test
 Test Results
   Ellison, P. Myths and Misconceptions about AD/HD: Science over

   Quinn, P. Gender Differences of AD/HD.

   Booth, B. Et al.: Myths about AD/HD. Metro Area Adult ADHD
    Network of Detroit.

   Richardson, W. The Link between ADD/ADHD and Eating
    Disorders: Self Medicating with Food.

   Hallowell, E. Delivered from Distraction.

   Amen, D. The Amen Clinic. and