7/6/2011
Sit Still and Learn: ADHD Penny Corkum, PhD (Registered Psychologist) Associate Professor, Psychology Department Scientific Staff, IWK Health Centre Director of Research and Development, ADHD Clinic, CEHHA Presentation to: Academy in School Mental Health July 11-12 & 14-15, 2011
Questions to be Answered What is ADHD? Is ADHD real or an excuse for bad behaviour? How is ADHD assessed and diagnosed? What are the common features of ADHD? H iis ADHD treated? How t t d? – Medication – School • Remediation • Accommodations Q&A
Academy in School Mental Health
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
ADHD A rose by any other name would smell as sweet (Shakespeare)
Current Diagnostic Criteria ADHD (DSM-IV) Three subtypes InA (6/9) HI (6/9) Combined (6/9 InA, 6/9 HI) Present in at least 2 settings S Symptoms t bbefore f age 7 Lasts longer than 6 months Developmentally inappropriate More frequent and severe Affects academic or social functioning Rule out other causes “The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder, and are not better accounted for by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder)
Academy in School Mental Health
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
ADHD Basics
ADHD – Is It Real?
ADHD (3 subtypes) is diagnosed in ~5% of elementary school-aged children 65-80% of children diagnosed with ADHD continue to reach diagnostic criteria in adolescents (“lifespan disorder”) Changing symptoms of ADHD Inattention: Persists across time Impulsivity: Declines (but not normalized) Hyperactivity: Declines (but not normalized) Comorbidity is high and can change overtime Only 20% of children with ADHD have only ADHD! 40% have one other disorder, 30% two other disorders, 10% three + other disorders ADHD (and comorbidity) puts an individual at risk for social, academic, behavioural and work problems Academy in School Mental Health
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
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7/6/2011
Biological Basis of ADHD
Assessment & Diagnosis
Imaging (functional and structural) studies Differences in fronto-striatal networks
Behavioural Genetics Estimated at .80 80 (range .50 50 to .98) 98) No definite mode of inheritance has been established Most likely not a single gene locus, but rather polygenic Recent association studies implicate genes within the dopamine system in the etiology of ADHD Dopamine system innervates frontal-striatal circuits
Not all that looks like ADHD is ADHD Or You can’t judge a book by its cover
Academy in School Mental Health
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Assessment Rubric Kamphaus & Frick, 2002 Assess core symptoms and severity/impact Assess onset and developmental course
Protocol Has To Include… Multiple assessment measures Standardized Testing Observation Interviews Informal Procedures
Data collected from multiple sources
Rule out alternative causes
Home, School, Community
Multidisciplinary team
Rule in comorbidities
Across institutions Mental Health, Health, Education
Academy in School Mental Health
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Problems with ADHD Assessments Over-reliance on questionnaires! Lack of differential diagnosis Co-morbid disorders not assessed Resulting in… Overdiagnosis Underdiagnosis Misdiagnosis
Role of Teachers in Diagnosis Do not diagnose or label …share your observations Help parents know how to access the diagnostic services they need & how to evaluate what comprises a good assessment Be an active participant in the diagnostic process Teachers are the best informants, so share all your knowledge with the psychologist or physician who is conducting the assessment
Academy in School Mental Health
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
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7/6/2011
Neurodevelopmental Framework
Alexander Luria (1902-1977) Attention – 3 units Unit 1 – Arousal/Alertness Unit 2 - Processing Unit 3 – Executive functions
Academy in School Mental Health
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Executive Functions in ADHD Brown, 2005 Executive Functions Activation
Focus
Effort
Executive Function Deficits
Emotion
ADHD
Memory
Action
Neurodevelopmental Framework All Kinds of Minds Attention Higher Order Cognition Language Memory Neuromotor Functioning Social Cognition Spatial ordering Temporal Sequential ordering
Academy in School Mental Health
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Treatment
Medication Effective in reducing core symptoms of ADHD BUT Doesn’t work with every child with ADHD P bl Problems with i h acceptance andd compliance li Side-Effects Reduces symptoms but does not improve adaptive functioning Not a remedy!
Academy in School Mental Health
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
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7/6/2011
Solution
Educational Interventions
Focus interventions on accommodation not remediation
Need a framework‌cannot intervene based on the label
pp y not a Use medication as a window of opportunity long-term solution
Each framework has strengths and weakness and knowing more than one is useful; however, however the framework you use needs to be geared to learning
Teach the skills the child will need to be an effective learner and a full and productive participant in society
All Kinds of Minds provides an highly relevant framework for understanding, assessing and intervening with children who have attention and learning difficulties
Academy in School Mental Health
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Neurodevelopmental Framework All Kinds of Minds Attention Higher Order Cognition Language Memory Neuromotor Functioning Social Cognition Spatial ordering Temporal Sequential ordering
Attention Mental Energy Processing Controls Production Controls
http://www.allkindsofminds.org/
Academy in School Mental Health
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Key Points Interventions need to be‌ Multifaceted I di id li d Individualized Proactive Collaborative (including the youth, school, home)
Academy in School Mental Health
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
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7/6/2011
Unsupported Treatments Dietary management (e.g., sugar, food dyes, etc.) Nutritional or dietary supplements (e.g., fatty acid)
Youth Focus Groups Main Findings Couldn’t think of many good things about ADHD Mixed feelings about medication
Homeopathic remedies
Not very knowledgeable about other treatments for ADHD
Chiropractics
Feel that others do not know about ADHD (“think you are stupid, lazy, crazy, bad”)
Neurological treatments (e.g., biofeedback, sensory-motor integration training) Yoga, message, green outdoor settings
Want others to know that …”they are not much different than others, teach us the way we learn, don’t expect us to make mistakes, don’t wait for us to mess up, treat us the same way as you treat others”)
Academy in School Mental Health
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
The Good Things To name a few … Spontaneity Creative Risk taker Not shy Multi- tasker Enthusiastic Fun…..
Resources Online Resources All Kinds of Minds http://www.allkindsofminds.org/ TeachADHD http://www.aboutkidshealth.ca/teachadhd Misunderstood Minds http://www.pbs.org/wgbh/misunderstoodminds/ Totally ADHD http://totallyadd.com/ Canadian ADHD Resource Alliance http://www.caddra.ca CHADD Canada http://www.chaddcanada.org/
Local Organizations Learning Disabilities Association of Nova Scotia (902-423-2850)
Books and Videos ADD Warehouse http://addwarehouse.com
Academy in School Mental Health
Academy in School Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
Presented by: Sun Life Financial Chair in Adolescent Mental Health
QUESTIONS
“CHILDREN DO WELL IF THEY CAN. IF THEY CAN’T, WE AS ADULTS NEED TO FIGURE OUT HOW WE CAN HELP” (Ross Greene) Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health
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