Attention Deficit Hyperactivity Disorder

1. Attention Deficit Hyperactivity Disorder Inappropriate behavior, including poor attention skills, impulsivity, and hyperactivity

2. Attention Deficit Hyperactivity Disorder • Behavioral disorder emerges before the age of seven • Symptoms include inattentive, impulsive and hyperactive behaviors • ADHD is not a reflection of a child's intelligence nor caused by poor parenting • ADHD is more common in people who have a close relative with the condition • Twice as many boys are diagnosed with ADHD as girls

3. What Is The Difference Between ADD and ADHD • The current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) outlines the diagnostic criteria for mental conditions. • Although the terms ADD and ADHD are used interchangeably, ADHD is the official name used by the American Psychiatric Association, and it encompasses hyperactive, impulsive, and/or inattentive behaviors. • ADD is the older term thus in some older literature you will find this term as a synonym for ADHD

4. Attention Deficit Hyperactivity Disorder: Prevalence • Affects children, adolescents and adults • It is one of the most common childhood psychiatric conditions in the United States. • The National Institute of Mental Health (NIMH) estimates that 5 million children in the United States have ADHD – that is about 5% of all children! • Studies show that up to 70% of children with ADHD continue to have symptoms as adults

5. Attention Deficit Hyperactivity Disorder: In Children • Childhood ADHD -- attention-deficit/hyperactivity disorder -- is diagnosed after a child has shown six or more specific symptoms of inactivity and/or hyperactivity on a regular basis for more than six months in more than two settings. • There is no single test for ADHD • Diagnosis is based on questionnaires

6. Attention Deficit Hyperactivity Disorder: In Children • A doctor can diagnose ADHD with the help of standard guidelines. • The diagnosis of ADHD involves the gathering of information from several sources, including school, caregivers, and parents. • The doctor will consider how a child's behavior compares with that of other children the same age.

7. TYPES OF ADHD • Combined Type (Inattentive/Hyperactive/Impulsive). Children with this type of ADHD show all three symptoms. This is the most common form of ADHD. • Hyperactive/Impulsive Type. Children show both hyperactive and impulsive behavior, but are able to pay attention. • Inattentive Type. Formerly known as attention deficit disorder (ADD), these children are not overly active. They do not disrupt the classroom or other activities, so their symptoms might not be noticed.

8. Attention Deficit Hyperactivity Disorder: In Teens • Typically diagnosed in childhood, ADHD still affects many teens. • The symptoms -- inattention, impulsivity, and hyperactivity - are intrusive, which means they interrupt and seriously interfere with a teen's life. • During teen years, especially as the hormonal changes of adolescence are going on, symptoms of ADHD may intensify.

9. Attention Deficit Hyperactivity Disorder: In Teens • It's not uncommon for teens with ADHD to forget assignments, misplace textbooks, and become easily bored with their daily class work. • Teens may become inattentive, or excessively attentive -- not waiting for their turn before blurting out answers. • They may interrupt the teacher and classmates, and rush through assignments.

10. Attention Deficit Hyperactivity Disorder: In Teens • Teens with ADHD may also be fidgety and have a difficult time sitting still in class. • Often, teens with ADHD are so busy focusing on other things they forget about the task at hand. This can be seen especially with homework and athletic skills and in relationships with peers. • This lack of attention to what they're doing often leads to poor performance on tests and being rejected from sports teams, extracurricular activities, and peer groups.

11. Attention Deficit Hyperactivity Disorder: In Teens • Teens with ADHD are more likely to be heavy drinkers than teens without ADHD. • In clinical studies, researchers confirmed that teens with ADHD were twice as likely to have abused alcohol within the past 6 months.

12. Attention Deficit Hyperactivity Disorder: In Teens • They also found that teens with ADHD were likely to abuse drugs and three times more likely to abuse drugs other than marijuana. • Getting proper treatment for ADHD in teens may cut the risk of later alcohol and drug abuse.

13. Attention Deficit Hyperactivity Disorder: In Adults • It is now known that these symptoms continue into adulthood for about 70% of children with ADHD. • That translates into 4% of the US adult population, or 8 million adults. • However, few adults are identified or treated for adult ADHD.  

14. Attention Deficit Hyperactivity Disorder: In Adults • Adults with ADHD may have difficulty following directions, remembering information, concentrating, organizing tasks or completing work within time limits. • If these difficulties are not managed appropriately, they can cause associated behavioral, emotional, social, vocational and academic problems. 

15. Attention Deficit Hyperactivity Disorder: In Adults • The following behaviors and problems may stem directly from ADHD or may be the result of related adjustment difficulties: • Chronic lateness and forgetfulness. • Anxiety. • Low self-esteem. • Employment problems. • Difficulty controlling anger. • Impulsiveness.

16. Attention Deficit Hyperactivity Disorder: In Adults • Substance abuse or addiction. • Poor organization skills. • Procrastination. • Low frustration tolerance. • Chronic boredom. • Difficulty concentrating when reading. • Mood swings. • Depression. • Relationship problems.

17. Attention Deficit Hyperactivity Disorder: In Adults • These behaviors may be mild to severe and can vary with the situation or be present all of the time. • Some adults with ADHD may be able to concentrate if they are interested in or excited about what they are doing. Others may have difficulty focusing under any circumstances. • Some adults look for stimulation, but others avoid it.

18. Attention Deficit Hyperactivity Disorder: Interesting Facts • Adults with ADHD are more likely to: • Change employers frequently and perform poorly. • Have had fewer occupational achievements • Have a lower socioeconomic status. • Have driving violations such as: be cited for speeding; have their licenses suspended; be involved in more crashes; rate themselves and others as using poorer driving habits.

19. Attention Deficit Hyperactivity Disorder: Interesting Facts • Adults with ADHD are more likely to: • Use illegal substances more frequently. • Smoke cigarettes. • Self-report psychological maladjustment more often • Have more marital problems and multiple marriages. • Have higher incidence of separation and divorce. • Much of this functional impairment diminishes with remission of the disorder and can be mitigated by appropriate treatment.

20. Common Conditions That Coexist With ADHD

21. Attention Deficit Hyperactivity Disorder The Medical Approach

22. Medication for ADHD • A class of drugs called psycho-stimulants or stimulants have been used to effectively treat ADHD for years. • They work by increasing the production of two neurotransmitters – dopamine and norepinephrine

23. Medication for ADHD • These medicines help users to focus their thoughts and ignore distractions. • Stimulant medications are effective in 70% to 80% of patients. • However there are short and long term effects related to these drugs

24. Medication for ADHD • Stimulant drugs to treat ADHD include: • Adderall and Adderall XR • Concerta • Dexedrine • Focalin and Focalin XR • Metadate CD and Metadate ER • Methylin • Ritalin, Ritalin LA • Vyvanse • Desoxyn

25. Side Effects of ADHD Drugs • ADHD drugs sometimes have side effects • The most common side effects of ADHD drugs include: • Decreased appetite/weight loss • Sleep problems • Headaches • Jitteriness • Social withdrawal • Stomach aches

26. Side Effects of ADHD Drugs • Rarely, medications for ADHD can cause more serious side effects. • For instance, some stimulants are associated with an increased risk of cardiovascular problems and sudden death. • They may also exacerbate psychiatric conditions like depression or anxiety.

27. Stimulant Safety ConcernsEffect On The Developing Brain • The long-term impact of ADD / ADHD medication on the youthful, developing brain is not yet known. • Some researchers are concerned that the use of drugs such as Ritalin in children and teens might interfere with normal brain development.

28. Stimulant Safety ConcernsHeart Related Problems • ADHD stimulant medications have been found to cause sudden death in children and adults with heart conditions. • The American Heart Association recommends that all individuals, including children, have a cardiac evaluation prior to starting a stimulant. • An electrocardiogram is recommended if the person has a history of heart problems.

29. Stimulant Safety ConcernsPsychiatric Problems • Stimulants for ADD / ADHD can trigger or exacerbate symptoms of hostility, aggression, anxiety, depression, and paranoia. • People with a personal or family history of suicide, depression, or bipolar disorder are at a particularly high risk, and should be carefully monitored when taking stimulants.

30. Stimulant Safety ConcernsPotential for Abuse • Stimulant abuse is a growing problem, particularly among teens and young adults. • College students take them for a boost when cramming for exams or pulling all-nighters. • Others abuse stimulant meds for their weight-loss properties. • If your child is taking stimulants, make sure he or she isn’t sharing the pills or selling them.

31. Stimulant Contraindications • ADD / ADHD stimulants are not recommended for those with: • Any type of heart defect or diseases • High blood pressure • Hyperthyroidism • Glaucoma • High levels of anxiety • A history of drug abuse

32. Attention Deficit Hyperactivity Disorder The Brain

33. ADHD AND BIOLOGICAL FACTORS • First identified in 1902 • Initially classified as serious brain damage • Precise causes still unknown • New research proves that ADD/ADHD is closely tied to: • Brain size • Brain density • The way brainwaves are produced

34. PREFRONTAL CORTEX • Smaller Prefrontal Cortex • Key functions include impulse control, socialization, reason and judgment • ADHD children are more prone to drifting off, making sudden outbursts or using poor judgment

35. NERVE TISSUE • Nerve tissue is smaller and thinner • Less connections • Scientists believe that these variations can affect a child's attention and impulse control.

36. NEUROLOGICAL DYSREGULATION • Brainwave Imbalance • May be caused by: • Variations in brain structure • Drugs • Toxins • Poor Nutrition • Subluxation • Trauma • Stress – both physical and emotional

37. NEUROLOGICAL REGULATION • The ability of the brain to regulate itself • Mental states are associated with specific brainwaves • These brainwaves include: • Delta • Theta • Alpha • Beta

38. DELTA BRAIN WAVES • Produced during deep sleep • Associated with the release of Human Growth Hormone

39. THETA BRAIN WAVES • This is the predominant brainwave that your brain produces when you are just about to fall asleep • It is associated with creativity and memory retrieval • This is why you seem to get your best ideas just as you are falling asleep. It is also why you typically remember things when you are just about to fall asleep.

40. THETA BRAIN WAVES • When the brain is dysregulated it sometimes produces high levels of Theta in the waking state • In these cases it is associated with: • Distractibility • Inattention • Daydreaming • Excessive amounts of Theta are typical in individuals with ADD

41. ALPHA BRAIN WAVES • Associated with meditation and a sense of inner calm or peacefulness • They are produced when the brain is in an idle state • This mental state is sometimes described as a quiet alertness

42. BETA BRAIN WAVES • The brain produces brain waves when we are: • Awake • Alert • Externally focused • Logical • Problem solving • Attentive

43. BETA BRAIN WAVES • Beta Waves are produced in the cortex • Children with ADHD typically have a smaller cortex so they very often produce less Beta Waves than normal

44. THETA BETA RATIO A Key Diagnostic Finding in ADHD

45. THETA BETA RATIO • Normal Theta / Beta ratios are • 2:1 in adults and • 2.5:1 in children • Ratios higher than 3:1 suggest ADD/ADHD • In several different studies it was demonstrated that 86% of the children diagnosed with ADHD using traditional criteria had a T/B ratio higher than 3:1

46. BRAINCORE THERAPY

47. BRAINCORE THERAPY AND ADHD • Neurofeedback is a training procedure designed to teach children with ADHD how to control their own brainwaves bringing balance, harmony and regulation to the brain • The goal of neurofeedback is to transform an unhealthy brainwave pattern into a healthy one

48. THE BRAINCORE APPROACH • Painless • Drugless • Non-Invasive • And Has No Side Effects

49. THE BRAINCORE EVALUATIONA Window To the Brain • The EEG evaluation begins by placing surface sensors at specific sites on the scalp • These sensors detect brain waves and display them on the computer screen

50. THE BRAINCORE EVALUATIONA Window To the Brain • During the course of the next 10 minutes the patient is asked to perform several tasks while the BRAINCORE software monitors the brainwaves • A report is generated demonstrating imbalances associated with ADHD such as a high Theta Beta Ratio