ADHD: A Return to Psychology - PowerPoint Presentation

Slide1

ADHD: A Return to Psychology Craig Wiener Ed.D.

Assistant Professor

: University of Massachusetts Medical School,

Department of Family Medicine and Community Health

Clinical Director

: Family Health Center of Worcester

Private Practice Slide2

Current view Delayed “inhibitory mechanism” Biogenetic problem Difficulty restraining short sighted responses

9% of children

Akinbami, L. J., X. M. Liu, P. N. Pastor, and C. A. Reuben. 2011Slide3

Traditionalists believe that people will be enticed by instant gratifications unless they can Inhibit immediate reactionsengage “executive functioning”and concentrate so that effective longer-term responses can be considered

(

Fuster

, 1997; Barkley, 2006). Slide4

Inferior biological/mental inhibitory mechanismLess ableTo stop, look, listen, and think before taking action (Douglas, 1972).They will not manage their futures effectively Slide5

Traditional ADHD is based on three pillars (Pliszka, Mc-Cracken, and Maas, 1996). Slide6

ADHD is thought to be a biological problem because It runs in familiesIdentical twins are almost always concordant

Molecular Biology is different

7-repeat allele (DRD4)

Increase diagnosis 50%

LaHose

et al., 1996; Barkley, 2006Slide7

Brain structure and function are differentBrain structures smaller and less differentiatedDiminished arousal and activation

Less availability of

neurotransmitters

dopamine and norepinephrine

Barkley, 2006; Brown, 2010Slide8

Medications work instantaneouslySince changing biology improves ADHDthe etiology of the behaviors must be biological Slide9

In critique of the three pillarsIn comparison to other medical problemsNo biological markers or dysfunctions that reliably coincide with the diagnosisToo many false positives and false negativesSlide10

The genetic argument is not as strong as it appears There are many diagnosed persons without the genetic variations

There are many

non-diagnosed

persons with the variations Identified molecular biology

Only increases the chance of diagnosis from 9% to 13.5%

Hardly a reason to panic is your child has the identified genes

(Chang, 1996: Shaw, 2007) Slide11

It is anticipated that family members will show similar behaviors Related people have similar bodies and environments Their probabilities for learning are similarExtreme with identical twinsA heightened confounding of genetics and learning Slide12

Yes, biology changes the probability of what is learned

Height

 Basketball player

Physically Attractive  Popular

Physically Awkward  Low Social Status, Sports AvoidanceSlide13

Biological difficulties can increase the probability of learning ADHD

For example

Developmental Delay

Coordination DisorderSpecific speech or learning problems

Health complications

Short attention span with objects

High activity levels

Demanding and intense responses

Negative infant temperament (Barkley, 2006)Slide14

Socializing a person to be concerned for others and independently responsible is difficult under these arduous conditions Slide15

But not all children with these problems will learn ADHD behaviors And learning can also change biologyDopamine levels can increase with positive experiences Schultz, Dayan, & Montague, 1997;

Wickelgren

, 1997 Slide16

With musiciansThe planum temporalebecomes largermore asymmetrical As a consequence of playing a musical instrument

Gaser

and

Schlaug, 2003 Slide17

This means that structural brain differences can occur as a result of learning These differences show relationships betweenpatterns of living and biological developmentsThe consequence of the co-occurrence of biology and environmentSlide18

And Differences in brain response may relate to learning as well MRI data showsBrain blood flow varies in relation to observing someone with the same or different political affiliationPatterns of brain activation and arousal can be a function of what the person is doing and what the person has learned

Elias, 2004Slide19

Finally, Medicine might lessen ADHD Behavior But this does not identify the cause of ADHDAlcohol helps with sociability, but this does not tell us why the person was not social Slide20

ADHD medications can be a potent and practical solutionDue to urgency and resources of participants

But they do not tell us about the genesis of ADHD Slide21

Instead of thinking that ADHD is a biological deficit caused by genetics Ask yourself: Why would a biological disability respond so remarkably toBribery Personal interest

Instruction source

(child initiated or expected by others)

How can a person outperform his disability?

Many parents ask,

“Why can my child function so well when he is doing what he wants to do?”Slide22

It is quite reasonable to assume If the problem goes away when there is “personal interest” then the problem is psychological Slide23

Do you see your child in the following cartoons?Slide24

by Brian Nelson “Sun

Spott

Studios”

Hyperactivity occurs when parents are on the phone

CartoonsSlide25

But not if bedtime is extended while the parent talks Slide26

Distractibility prevails when writing a “thank you” note Slide27

But not when writing a Christmas listSlide28

Blurting occurs when vying for attention or provoking Slide29

But not when there could be incriminationSlide30

Unpleasant appointments are often missedSlide31

But it’s first in line for scheduled trips to the moviesSlide32

The daily planner Is cast aside Slide33

While plans on “My Space” are being madeSlide34

Personal belongings arescattered aboutSlide35

But battle scenes are meticulously arrangedSlide36

Chores are left undoneSlide37

But the house sparkles when “buttering up” the parentSlide38

Contemplation is evident when making a purchase Slide39

But not when shopping for a siblingSlide40

Rather than disability

ADHD behavior is

reinforced

in particular situations Slide41

Your goal is to stop those reinforcements and instead foster your child’s self-reliance and cooperationSlide42

Works cited Akinbami, L. J., X. M. Liu, P. N. Pastor, and C. A. Reuben. 2011. “Attention Deficit Hyperactivity Disorder among Children Aged 5–17 Years in the United States, 1998–2009.” NCHS Data Brief No. 70. August. http://www.cdc.gov/nchs/data/databriefs/db70.pdf.Barkley, R. A. Advances in ADHD: Theory, Diagnosis, and Management. J & K Seminars, 1861 Wickersham Lane, Lancaster, PA 17603, 2008.______.

Attention Deficit Hyperactive Disorder: A Handbook for Diagnosis and Treatment .

New York: Guilford Press, 2006.

______. Attention Deficit Hyperactive Disorder: A Handbook for Diagnosis and Treatment.. New York: Guilford Press, 1998.______. ADHD in Children, Adolescents and Adults: Diagnosis, Assessment, and Treatment.

New England Educational Institute, Cape Cod Summer Symposia (Audio cassettes). New England Educational Institute, Pittsfield, MA, 2000.

Brown, T. Recognizing and treating adult ADHD. In

Shnitzer

, N.

New England Psychologist. Vol. 18, no. 5, p. 2, June 10, 2010. Chang, F., Kidd, J., Livak, K.,

Pakstis

, A., Kidd, K., “The World-Wide Distribution of Allele Frequencies at the Human Dopamine D4 Receptor Locus”,

Human Genetics

, 98, (1996): 91-101.

Douglas, V. I. “Stop, Look, and Listen: The Problem of Sustained Attention and Impulse Control in Hyperactive and Normal Children.”

Canadian Journal of

Behavioural

Science

4 (1972): 259–82.

Elias, P. “Brain Scans a Political Tool?”

Telegram & Gazette. October 29, 2004, A13.Fuster, M. M.

The Prefrontal Cortex

(3d ed.) New York: Raven, 1997.

Gaser

, C., and G.

Schlaug

. “Brain Structures Differ between Musicians and Non-Musicians.”

The Journal of Neuroscience

23, no. 27 (2003): 9240–45.

A. O., &

Bedi

, R.P. The alliance. In J. C. Norcross (Ed.),

Psychotherapy relationships that work: Therapist contributions and responsiveness to patients

(p. 37-69). New York: Oxford University, 2002.

LaHoste

, G. J., J. M. Swanson, S. B.

Wigal

, C.

Glabe

, T.

Wigal

, N. King, et al. “Dopamine D4 Receptor Gene Polymorphism is Associated with Attention Deficit Hyperactivity Disorder.”

Molecular Psychiatry

1 (1996): 121–24.

Pliszka

, L. R., J. T. McCracken, and J. W. Maas. “

Catecholamines

in Attention Deficit Hyperactivity Disorder: Current Perspectives.”

Journal of the American Academy of Child and Adolescent Psychiatry

35 (1996): 264–72.

Schultz, W., P. Dayan, and P. R. Montague. “A Neural Substrate of Prediction and Reward.”

Science

275 (1997): 1593.

Shaw, P. et. al. Polymorphisms of the Dopamine D

4

Receptor, Clinical Outcome, and Cortical Structure in Attention-Deficit/Hyperactivity Disorder,

Arch Gen Psychiatry.

2007;64:921-931.

Wickelgren

, I. “Getting the Brain’s Attention.”

Science

278

(1997): 35–37.