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Attention Deficit Hyperactivity disorder

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Attention Deficit Hyperactivity disorder Powered By Docstoc
					 Welcome to the world of
     ADD………….

Where landing is learned in
         midair.
   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
  psychosis
 It is an excuse to not take responsibility for
 What are the characteristics of
            AD/HD?
 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
          AD/HD
 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
             behavior?
 Fails to pay close attention to details
 Makes careless mistakes
 Can’t stay on task
 Doesn’t seem to listen when spoken to
  directly
 Constantly losing or forgetting important
  things
 Talks excessively
 Blurts out answers
 Difficulty awaiting their turn
   What is the difference between
         ADD and AD/HD?
 The  correct disorder is currently termed
  AD/HD
 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
      expressed
     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
 expression:
     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
      brain.
    Pathophysiology of AD/HD
   AD/HD has been shown to have problems in the
    catecholamine rich fronto-subcortical brain
    regions.
      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
    without.
      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
      work
Executive functions of the brain

 Working memory         and recall
     Holding facts in mind while manipulating
      information
     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

     ideas.
        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
    worse.

   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
    hyperactivity:
      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
      socially
 If   the limbic system is overactive:
      Clinical depression
      Bipolar disorder
      Severe PMS (PMDD)


 Nutritional   support
      Our limbic system needs fat to operate
       properly
      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
  behavior.

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


     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
 supportive.
     A decrease in phosphatidal serine causes
      severe memory problems. Supplementation
      may be recommended.
               Brain imaging




Normal Brain                      ADHD brain
                  Image of ADHD
                                  on Adderall
                  brain
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

     level
    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
      intend
     Project confidence and feel incredibly
      insecure
     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,
  (stubborn)
 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.
 http://amenclinics.com/ac/
 http://amenclinics.com/ac/tests/subtype_te
  st1.php
 ADD Test
 http://amenclinics.com/ac/tests/subtype_re
  sults.php
 Test Results
                         Sources
   Ellison, P. Myths and Misconceptions about AD/HD: Science over
    Cynicism. www.addconsults.com

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

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

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

   Hallowell, E. Delivered from Distraction.

   Amen, D. The Amen Clinic. www.brainplace.com and
    www.amenclinics.com

   www.chadd.org

				
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