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question
 Do
you have a parent organization?
WHO IS GUILTY?
 This
is what you may hear from your close
environment:
 The child is healthy – nevertheless there
are problems, how is that?
 When the child is involved in an accident –
(for instance has taken(read: drinking)
toxins) you are guilty
 You do not provide structure the child
needs
Research of Russ Barkley and
Cunningham
 OBSERVATIONAL STUDIES
INDICATE
THAT MOTHERS ARE ACTING IN A
NEGATIVE WAY TOWARDS THEIR
CHILD WITH ADHD: THEY ARE
COMMANDING, VOICE MUCH
CRITICISM
 WHAT
IS THE DIRECTION?
MOTHER - CHILD
 TEST:
THE DUO HAD TO RESOLVE
PROBLEMS – THEY HAD TO WORK AS
A TEAM
 WHEN
CHILD WAS ON MEDICATION
(METHYLPHENIDATE) THE MOTHER
WAS ACTING LESS NEGATIVE
CONCLUSION
CONCLUSION
 NEGATIVE
BEHAVIOR EMANATES
FROM THE ADHD CHILD

STROES ALBERTS AND VAN
DER MEERE. JAACP (2004)
 CHILD
WITH ADHD – STUDENT
 SPONTANEOUS
BEHAVIOR OF THE
STUDENT
 CHILD
TRIGGERED STRUCTURE
PROVIDING BEHAVIOR IN THE
STUDENT IN LESS THAN A MINUTE
WHAT MAKES THE CHILD WITH
ADHD SO VULNERABLE?
 1)
HE/SHE LOOKS HEALTHY
 2)
PERFORMANCE FLUCTUATES
 3)
HE CAN WHEN HE WANTS
DEFINITION OF ADHD
 FLUCTUATIONS
IN STATE IS CHILD’S
TRAIT
– BRAIN
 CLUMSINESS – BRAIN
 MOTIVATION – BRAIN (GUILTY?)
 READING
COMORBIDITY

Motivation versus cognitive deficit

– Oppositional Defiant Disorder
Conduct Disorder

- Learning disabilities
 ADHD
Theory of state regulation
Van der Meere (2005) In Gozal & Molfese ADHD:
from genes to patients Totowa NJ Humana press)
Actual state vs. required (target) state – effort allocation
extra effort
Performance

no extra effort
optimal state
non-optimal state
Signal rate
50
45
40
35
30
25
20
15
10
5
0
ADHD
Controls
others
fast
slow
Controls > ADHD: Fast Go Correct
ADHD > Controls: Fast Go Correct
Controls > ADHD: Slow Go Correct
ADHD > Controls: Slow Go Correct
Controls > ADHD: Slow NoGo Correct
ADHD > Controls: Slow NoGo Correct
Nucleus Reticularis Thalami

NRT is a neural sheet draped over the lateral/anterior
aspects of the thalamus
 NRT is the functional interface between the arousal
and attention systems
 Receives axonal collaterals from corticothalamic,
thalamocortical and reticular formation projections
Portas et al. 1998, J. of Neuroscience, 18
Stress response defined in terms of
occurrence of facial movements
Lips Part
Lip Pressor
Jaw drop
Lip Suck
Van der Meere, Börger, & Wiersema (submitted)
Mean
frequencyfrequentie
facial movements
Gemiddelde
lipspart
30
20
Aantal
10
jjjjj
jjjjj
jj
group
groepscode
Controle
0
ADHD
1
2
Periode
Time
on task
3
4
5
6
conclusion
 ADHD
associated with poor state
regulation (underactivation) : in common
parlance “poor motivation.
 More
research needed on factors that
regulate energy metabolism in ADHD
IN THE MEANTIME
 RESEARCH
INDICATED THAT THE
SEVERITY OF THE ADHD SYMPTOMS
IS RELATED TO STRESS
EXPERIENCED BY PARENTS
 See: Anastopoulos
et al (1992). Parenting
stress among families of children with
ADHD. Journal of Abnormal Child
Psychology, 20, 503- 520.
Stress in families
 Symptom
Checklist 90-Revised
(Derogatis, 1983). Manual for the SCL-90.
Baltimore, MD.
 90 items 5 point scale
 Depression and somatic complains
Reduce stress
therapy/ parent training – it leads to
an increase in parenting self-esteem and
reductions in overall stress
 Behavioral management principles
 Family
 Take
breaks