Download ADHD: The Biology Behind the Behavior Presentation

MORABETO MIND LEGACY ASSOCIATES INC.
With Instructor:
Janice R. Morabeto M.Ed. L.S.W. C.H.T.
ON DEMAND TRAINING MODULES
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ADHD: A BIO-PSYCHO-SOCIAL APPROACH TO
UNDERSTANDING
COURSE DESCRIPTION

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.
AGENDA: TO EXPLORE THE CURRENT
RESEARCH
In neuroanatomy as it relates
to understanding ADHD as a
disorder with specific
biological impairments.
In molecular genetics to
understand how ADHD has
been shown to be particularly
hereditary
In neurochemistry as it
relates to understanding
ADHD as a disorder with
specific neurochemical
imbalances.
HOW ABOUT A LITTLE REVIEW!
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Take this 5 question pre-test to review and
learn!
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Spend only 2-3 minutes on it
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Answers will be reviewed before I continue with
the presentation.
HOW CAN THIS INFORMATION HELP YOU TO BE
MORE EFFECTIVE IN WORKING WITH THESE
CHILDREN?
 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
True?
False?
1. There are three types of ADHD.
2. The three subtypes of ADHD are Inattentive, Hyperactive,
and Combined.
3. ADHD is a childhood disorder and evidence of it must first
be seen before age 7.
4. 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 underarousal.
PRIMARY SYMPTOMATOLOGY

Hyperactive-Impulsive Type
 Hyperactivity
In children
 Inability
to modulate locomotion; squirming , fidgeting,
excessive climbing
 Hyperactivity
in Adults
 Restlessness,
irritability, difficulty relaxing
HYPERACTIVE-IMPULSIVE TYPE CONT.

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
INATTENTIVE TYPE

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.
ON THE OTHER HAND!

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.

First Things First: A look
at a healthy brain and
nervous system.
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The human brain is the
most complex structure
on earth.
Comprised of
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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
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
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NEURO-ANATOMICAL IMPAIRMENTS IN ADHD
NEURO-ANATOMICAL IMPAIRMENTS IN ADHD
 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:
PET SCAN COMPARISONS OF BRAIN WAVES
NEURO-ANATOMICAL IMPAIRMENTS IN ADHD
Corpus
Callosum
Prefrontal Cortex
Basal Ganglia
Cerebellum
NEURO-ANATOMICAL IMPAIRMENTS IN ADHD
Locus
Coeruleus
Reticular Activating System
Total White Matter Volume
NEURO-ANATOMICAL IMPAIRMENTS IN ADHD

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
 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
 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
 The
Activating System
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.
IMPAIRMENTS IN ADHD: PICTORIAL
NEUROTRANSMITTERS RELATED TO
IMPORTANT MENTAL PROCESSES AND
ADAPTIVE BEHAVIORS
WHEN IT COMES TO NEUROCHEMISTRY
WELLNESS = BALANCE
 The
three major categories of substances
that act as neurotransmitters are
 Amino
Acids
 Peptides
 Monamines

Amino Acids
 Glutamic
acid or Glutamate
 GABA
Aspartic acid
 Glycine

Workhorses
of the Brain
 Peptides
 Vasopressin


Somatostatin
Neurotensin, etc.
 The
peptides perform specialized functions in the
hypothalamus or act as co-factors elsewhere in the
brain.

Monoamines
 Norepinephrine,
 Dopamine
Serotonin
 Acetylcholine

The
monoamines & acetylcholine perform
specialized modulating functions and are often
confined to specific structures.
 Dopamine
Gusto” Neurotransmitter
 Implications in motivation, reward and
risk taking
Predictive of locomotive activity
“
 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
 Serotonin
 Has
been called the “Master neurotransmitter”
 Has
 Mood,
regulatory effects on other neurotrasmitters
appetite, concentration, memory, sexual
function and arousal
ADHD BRAINS LACK NEUROCHEMICAL BALANCE
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Inattentive Type
Norepinephrine
Dopamine
Serotonin
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Daydreaming
Memory Impairment
Difficulty concentrating
Hyperactive-Impulsive Type
Norepinephrine
Dopamine
Serontonin
Hyperactivity
Impulsivity
Restlessness
WHAT’S HAPPENING IN THE FIELD OF MOLECULAR
GENETICS?
Are those people related??
FAMILY AND TWIN STUDIES
Between 10 and 35 percent of children with ADHD have a firstdegree relative with past or present ADHD.
Approximately one-half of parents who had ADHD have a child
with the disorder.
Over the past decade, a large number of twin
studies have shown that, when ADHD is
present in one twin, it is significantly more
likely also to be present in an identical twin
than in a fraternal twin.
GENETIC CONTRIBUTIONS TO ADHD

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
Dopamine D5 receptor gene (DRD5)
 Dopamine beta-hydoxylase gene (DBH)
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 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
KNOCK OUT MICE
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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.
GENETIC CONTRIBUTIONS TO ADHD
 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
IMPORTANT NOTE

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
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