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Attention Deficit Hyperactivity Disorder Inappropriate behavior, including poor attention skills, impulsivity, and hyperactivity 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 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 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 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 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. Common Conditions That Coexist With ADHD COMORBIDITY Learning Disorders Anxiety & Depression Bipolar Disorder Oppositional Defiance Disorder Conduct Disorder Tourette’s Syndrome Substance Abuse Obsessive Compulsive Disorder Intermittent Explosive Disorder Panic Disorder Specific Phobia CHILDREN ADOLESCENT X X X X X X X X X X X X X X ADULT X X X X X X X Attention Deficit Hyperactivity Disorder The Medical Approach 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 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 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 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 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. Stimulant Safety Concerns Effect 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. Stimulant Safety Concerns Heart 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. Stimulant Safety Concerns Psychiatric 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. Stimulant Safety Concerns Potential 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. 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 ATTENTION DEFICIT HYPERACTIVITY DISORDER AND NEUROFEEDBACK What is Neurofeedback Used For? Over 40 years of peer reviewed, university based research has demonstrated the efficacy of neurofeedback in addressing many neurological conditions ADHD Anxiety Panic Attacks Insomnia Chronic Pain Bedwetting Migraine Fibromyalgia TBI Tension Headache PTSD Depression Learning Disorders Autism / Asperger’s Tics As well as other conditions 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 ADHD AND NEUROFEEDBACK • A number of quality studies have been published that show the effectiveness of neurofeedback in alleviating some or all of the symptoms associated with ADHD • Neurofeedback research is based upon the principle that ADHD is connected with what is called hypo-arousal within the brain and central nervous system. This hypo-arousal is bio-electrical, or brainwave based in nature • Mental states are associated with specific brainwaves • Each brainwave represents a specific processing speed of the brain– also known as arousal level • These brainwaves include: – – – – Delta Theta Alpha Beta ADHD AND NEUROFEEDBACK • Delta and Theta represent the slowest processing speeds and are associated with a twilight state • Alpha represents a slightly faster processing speed and is associated with quiet wakefulness such as when you meditate • Beta represents the fastest processing speed and is associated with external focus, thought and concentration THE AROUSAL SPECTRUM A healthy, regulated brain is able to shift easily between arousal states as the demands arise LOW AROUSAL SLOWER PROCESSING Delta and Theta IDLE STATE OF THE BRAIN Alpha HIGH AROUSAL FASTER PROCESSING Beta OPTIMAL ZONE OF PERFORMANCE The Brain has an optimal zone of performance LOW AROUSAL SLOWER PROCESSING IDLE STATE OF THE BRAIN HIGH AROUSAL FASTER PROCESSING Depending on the circumstances and everyday demands, the brain may move toward low arousal or high arousal but a well regulated brain stays within its optimal zone of performance THE DYSREGULATED BRAIN UNDER-AROUSED INHIBITED OVER-AROUSED • A dysregulated brain has a tendency to habitually operate from one of the 3 arousal states THE DYSREGULATED BRAIN An individual’s habitual arousal state might be too high or too low to support optimal function UNDER-AROUSED Impulsive Socially Inappropriate Hyper-active Easily Distracted Excessive Speech Disorganized Hyper-emotional INHIBITED Victim Mentality Excessive Self Concern Rumination Anger Self Deprecation Agitation Irritability Passive Aggressive OVER-AROUSED Excessive Rationalization Poor Emotional Self Awareness Worry Hyper-vigilant Obsessive Thinking Dislike of Change Restless THE DYSREGULATED BRAIN An individual’s habitual arousal state might be too high or too low to support optimal function UNDER-AROUSED Excessive Delta and Theta These patients usually present with cognitive impairment, focus and attention issues, ADHD, TBI, dementia, learning disorders INHIBITED Elevated Alpha These patients usually present with symptoms of depression, irritability, lethargy, fibromyalgia, metabolic issues OVER-AROUSED Elevated Beta These patients usually present with anxiety, panic attacks, OCD, worry, migraine, tension headache, chronic pain, insomnia NEUROLOGICAL DYSREGULATION • Brainwave Imbalance or Neurological Dysregulation may be caused by: – Variations in brain structure – Drugs – Toxins – Poor Nutrition – Subluxation – Trauma – Stress – both physical and emotional BRAINCORE THERAPY Painless Drugless Non-Invasive No Side Effects How is it Done? All neurofeedback begins by performing a Brain Map The BrainCore Brain Map A Brain Map provides us with the information that is required to perform neurofeedback training THE BRAINCORE BRAIN MAP REPORT The BrainCore Brain Mapping software analyzes thousands of different variables and compares your patient’s brain map with a database of normal brain maps to produce a the Brain Map report THE BRAINCORE BRAIN MAP REPORT The BrainCore Brain Map Report provides the neurofeedback protocols that will be used during the neurofeedback training HOW IS NEUROFEEDBACK DONE Individuals are hooked up to a computer using wires and sensors and the computer reads their brainwaves Information about these brainwaves is displayed on the doctors monitor The software automatically detects when the brainwaves are properly ordered and it feeds that information back to the patient This feedback appears in the form of a game, movie, or sound which signals the patient that the brainwaves are becoming more ordered Rollercoaster Video DVD’s and Movies THE BIG IDEA: When you have information on what your brain waves are doing, your brain can use that information to change how it works. 55 Learning Is Permanent • Once we learn something it becomes a permanent part of our behavior. • Follow up studies in neurofeedback show that the effects continue for up to 30 years. How Long Does it Take to Get Results? • • • • Trainees typically come for 20 sessions of training. Trainees come twice a week or more. Each session is 30-45 minutes long. They typically begin to see changes in about 5 to 8 sessions NEUROFEEDBACK IS BASED IN OVER 40 YEARS OF CLINICAL RESEARCH PROVING IT’S EFFICACY In fact, Dr Frank H. Duffy, a Professor and Pediatric Neurologist at Harvard Medical School, stated that “Neurofeedback should play a major therapeutic role in many difficult areas. In my opinion, if any medication had demonstrated such a wide spectrum of efficacy it would be universally accepted and widely used” BRAINCORE THERAPY QUESTIONS A GIFT