Morabeto Mind Legacy Associates Inc.

1. With Instructor: Janice R. Morabeto M.Ed. L.S.W. C.H.T. Morabeto Mind Legacy Associates Inc.

2. Enjoy the fact that you will not have to be traveling today to get your C.E.U. hours met! Get prepared to learn! If you normally take notes during lecture, do that as you take this On demand class. It will help you to remember what you learned better, longer and be able to apply that knowledge when you need it most! Take advantage of downloading and printing the PowerPoint presentations before class begins. Email me at info@mindlegacy.com if you have questions regarding the content of this material, or if you are interested in future C.E.U. Opportunities. On Demand Training Modules

3. ADHD: A bio-Psycho-Social Approach to Understanding The Biology Behind the Behavior

4. ADHD is the most common psychiatric disorder diagnosed in children in America. It remains, as well, one of the most controversial in terms of diagnosis and treatment approaches. Recently, the fields of neuroanatomy, molecular genetics and neurochemistry are beginning to shed some real light as to the complexities, and actualities of this important disorder. Course Description

5. Agenda: to Explore the current research

6. Take this 5 question pre-test to review and learn! Spend only 2-3 minutes on it Answers will be reviewed before I continue with the presentation. How about a little review!

7. Many people feel manipulated by the ADHD individual due to the inconsistencies of their behaviors. Knowing the biology behind the behavior will help you to realize that those who suffer from ADHD have not mastered developmentally appropriate skills; ie, communication, study skills and at times are lagging in maturity How can this information help you to be more effective in working with these children?

8. True? False?

9. There are three types of ADHD. • The three subtypes of ADHD are Inattentive, Hyperactive, and Combined. • ADHD is a childhood disorder and evidence of it must first be seen before age 7. • Some of the symptoms of ADHD Hyperactive-Impulsive Type are excessive talking, difficulty in moderating impulses, and a state of general over-arousal. • 5. Some of the symptoms of ADHD Inattentive Type are forgetfulness, disorganization and a state of general under-arousal.

10. Hyperactive-Impulsive Type • Hyperactivity In children • Inability to modulate locomotion; squirming , fidgeting, excessive climbing • Hyperactivity in Adults • Restlessness, irritability, difficulty relaxing Primary Symptomatology

11. Impulsivity in children • Inability to moderate behaviors i.e. excessive talking, butting into conversations, invading others’ personal boundaries, low frustration tolerance • Impulsivity in Adults • Continue to be consistent talkers who have not learned to listen to others in a genuine way, tend to change jobs more frequently, have more divorces, traffic violations and substance abuse problems including nicotine, caffeine and overeating Hyperactive-Impulsive Type cont.

12. In children: • Difficulties in memory, listening, following directions, lack of follow through, persistence, transitioning between tasks, daydreaming. • In adults • Difficulty in memory, planning, organization, follow through in work and in family lives. Less likely to finish high school or college and tend to advance slower than their peers. Inattentive Type

13. If they can channel their energy, enthusiasm and love of novelty, they can become very successful in the workplace. Studies show that about 1/3 of adults with ADHD can become entrepreneurs by their 30’s. On the other hand!

14. First Things First: A look at a healthy brain and nervous system. • The human brain is the most complex structure on earth. • Comprised of • 100 billion neurons • Connection with cells near and far • Can include up to 100 trillion connections • 3.5 lb of gray and white matter the size of a grapefruit

15. Dynamic nature – changes constantly in response to environmental stimuli • Major Job – to reach and maintain Homeostasis, the regularity of the internal environment, and to integrate and modulate incoming information from our senses • Modulates incoming information to ascertain the bodies need for and level of response

16. Neuro-anatomical Impairments in ADHD

17. Smaller anatomic areas and/or volumes in the following regions of the brain. Some studies suggest as much as 7-10% below the healthy control samples: Neuro-anatomical Impairments in ADHD

18. Pet scan comparisons of brain waves

19. Corpus Callosum • Prefrontal Cortex • Basal Ganglia • Cerebellum Neuro-anatomical Impairments in ADHD

20. Locus Coeruleus • Reticular Activating System • Total White Matter Volume Neuro-anatomical Impairments in ADHD

21. Corpus Callosum • the large bundle of axons which connect the two cerebral hemispheres. It disseminates information from the cerebral cortex on one side of the brain to the same region on the other side. • Prefrontal Cortex • Area of the brain that is devoted to many aspects of mature adult functioning such as judgment, reasoning, planning, rational thought, organization goal setting and follow through. Neuro-anatomical Impairments in ADHD

22. Basal Ganglia • group of structures which coordinate movement; located in the forebrain (telencephalon) • Cerebellum • structure located in the back of the brain involved in central regulation of movement, such as basic movement, balance, and posture; comes from the latin word meaning "little brain"; is divided into two hemispheres and has a cortex Neuro-anatomical Impairments in ADHD

23. Locus Coeruleus • Noradrenergic system supplies Norepinephrine (NA) throughout the central nervous system. Involved in processing of relevant or salient information as well as highly involved in startle reactions, stress and panic. • Reticular Activating System • The RAS acts as the executive secretary conscious awareness. It is the chief gatekeeper that screens or filters the type of information that will be allowed to get through. Neuro-anatomical Impairments in ADHD

24. Impairments in ADHD: Pictorial

25. Neurotransmitters related to important mental processes and adaptive behaviors

26. When it comes to neurochemistry

27. Wellness = Balance

28. The three major categories of substances that act as neurotransmitters are • Amino Acids • Peptides • Monamines

29. Amino Acids • Glutamic acid or Glutamate Workhorses • GABA of the Brain • Aspartic acid • Glycine

30. Peptides • Vasopressin • Somatostatin • Neurotensin, etc. • The peptides perform specialized functions in the hypothalamus or act as co-factors elsewhere in the brain.

31. Monoamines • Norepinephrine, • Dopamine • Serotonin • Acetylcholine • The monoamines & acetylcholine perform specialized modulating functions and are often confined to specific structures.

32. Dopamine • “Gusto” Neurotransmitter • Implications in motivation, reward and risk taking • Predictive of locomotive activity

33. Norepinephrine • Responsible for sustained attention • Fight and Flight Reaction (Little Brain) • Prepares the body for action • increase the heart rate as well as blood pressure

34. Serotonin • Has been called the “Master neurotransmitter” • Has regulatory effects on other neurotrasmitters • Mood, appetite, concentration, memory, sexual function and arousal

35. Inattentive Type Norepinephrine Daydreaming Dopamine Memory Impairment Serotonin Difficulty concentrating • Hyperactive-Impulsive Type Norepinephrine Hyperactivity Dopamine Impulsivity Serontonin Restlessness ADHD brains lack neurochemical balance

36. What’s Happening in the Field of Molecular Genetics? Are those people related??

37. Family and Twin Studies

38. Several genes have been consistently found to be a associated with ADHD • Dopamine D4 (DRD4) • Dopamine Transporter Gene (DAT) • Found to be also impaired in • Tourettes • Conduct Disorder • Obsessive-Compulsive Disorder Genetic Contributions to Adhd

39. Dopamine D5 receptor gene (DRD5) • Dopamine beta-hydoxylase gene (DBH) • Implicated in • Decreased concentrations of dopamine • Upregulated postsynaptic dopamine • (decreased amount available in the synapse) • Extracellular concentrations of dopamine • Brain’s inability to modulate dopamine levels to control behaviors and mental processes Genetic Contributions to Adhd

40. New advances in molecular genetics have enabled science to selectively “knock out” one gene in a sample of mice. By observing and contrasting generations of mice with and without a particular genetic influence behaviors can be observed, compared and contrasted. Knock out mice

41. Serotonin Transporter Gene (5HTTT) • Serotonn Receptor Gene (HTR1B) • Decreased concentrations of serotonin • Upregulated postsynaptic serotonin • (decreased amount available in the synapse) • Extracellular concentrations of serotonin • Brain’s inability to modulate serotonin levels to control behaviors and mental processes Genetic Contributions to Adhd

42. The genetic contribution to ADHD has been shown to be as high as 75% in some families, but! • Other possible causes can be: • Other psychiatric disorders in parents and first degree biological relatives • Substance use, abuse and dependency in mother, father and alcoholism and substance related disorders in families • Other medical problems that could have caused damage to the brain Important note

43. Review Flash Cards under Java Games These will highlight the important aspects of the class and prepare you for the quiz. Complete at least one more game, so that you can enjoy the review of this important information. You will also greatly increase the chances of passing the quiz the first time! You can also review this presentation as many times as you’d like. Whew!!! How about a little review!