Attention Deficit Hyperactivity Disorder

Workshop for AASC 22nd August, 2016

David O’Banion, MD Developmental Pediatrician, FAAP

Assistant Professor of Pediatrics

Emory University School of Medicine

glsr.it/ADHD4AASC

your participation is kindly requested

glsr.it/ADHD4AASC

a few disclaimers: I’m a doctor but… I don’t internet well...

Learner Objectives

the active participant will:

1.explain the reason ADHD is a disorder 2.describe how a clinician diagnoses

ADHD 3.define how ADHD symptoms impact a

child and family 4.debate ADHD issues glsr.it/ADHD4AASC

Today’s Timeline --- 90 minutes

• 5 min opening • 10 min ADHD challenges • 15 min ADHD biology • 20 min ADHD treatment • 20 min ADHD for AASC • 30 min debate club

glsr.it/ADHD4AASC

What do you already know? 3 things

• discuss in small groups

What do you already know? 3 things

pick three members each types one here

Defining ADHD – symptoms and challenges

difficulty paying attention

difficult to even start “attention” activities

difficult to focus on one task

poll re: video games; which of the following wouldn’t you expect? (evidence that it isn’t ADHD) • driving and texting • crying before starting homework • can play vid games and ignore others • something else • something depression

video game interaction: every ___ seconds?

hyperactivity: hard to sit still

huge problem = impatience

focus follow through sit still wait

3 star quest • Gary will sit for an hour playing World of Warcraft

online, but puts off completing his expense report from a recent business trip. He starts working on it late, and can only find one of the receipts he needs

3 star quest • Jackie would rather stay in her room than play with her

brother outside. She talks back to her mother angrily, and pesters her brother. She’s been kicked out of two daycares for playing too rough.

3 star quest • Derek cries and says “I’m stupid” when his mother

makes him work on his homework. She knows he can do the work, but he makes many mistakes and doesn’t check his answers. Then, he forgets to turn it in and doesn’t get credit at school.

ADHD has 18 core symptoms

ADHD has 18 core symptoms

diagnosis: most symptoms, most places

any licensed clinician can apply the diagnostic criteria

http://www.helpforadd.com/

Kids with ADHD are nice kids!

https://www.youtube.com/watch?v=Xd6Y6RzTDVc

life challenges due to poor planning skills

Learner Objectives

the active participant will:

1.explain the reason ADHD is a disorder 2.describe how a clinician diagnoses

ADHD 3.define how ADHD symptoms impact a

child and family 4.debate ADHD issues

What is the main reason kids get ADHD? • Sucrose (sugar) • Food dyes • Genetics • Brain damage • over stimulating environment • pregnancy problems • something else dietary • video games • something else in the environment

Results review & Recall of 1st question

ADHD Biology – basis and treatments

executive function: mature, adult brain skills

executive function: adult brain is last to develop

adult brain makes us uniquely human

info comes in… ignore, react, respond, or “think about it”

Think and Plan

Automatic Brain

Threat

Response

info comes in…

info comes in… ignore, react, respond, or “think about it”

Think and Plan

Automatic Brain

Clever Response

Input

Which is an example of executive function? a – spaghetti smell reminds you of home b – did you lock the front door? c – you brake just in time d – you ignore the sound of a text because your client is talking e – you’re certain you left your keys right here__

executive function: think and plan

ADHD brains are different

ADHD brains: volume, connections, symmetry differences

Shaw 2007

brain connections use chemicals to signal

ADHD brains: different connections (wiring)

Brain Tutor App

http://www.additudemag.com/adhd/article/10117.html

How do the medications work in ADHD? • over-stimulate an overactive brain • enhance neurotransmitter signaling • cause a kid to only be attentive to one thing at a time • calm a child down by making him/her slightly sleepy • improve blood flow to learning and attention centers in

the brain

medications enhance neurotransmitter signaling

most people inherit their ADHD

ADHD Diagnosis

ADHD present, not diagnosed

ADHD risk, sub threshold

Learner Objectives

the active participant will:

1.explain the reason ADHD is a disorder 2.describe how a clinician diagnoses

ADHD 3.define how ADHD symptoms impact a

child and family 4.debate ADHD issues

What is the recommended treatment? • medicine: non-stimulants should be first • behavior therapy should be first • improving diet should be tried first • counseling or play therapy • exercise therapy • medicine: stimulants should be tried first • all are effective and should be tried

behavior therapy tries to train

does diet affect behavior?

• picture taken from http://www.huffingtonpost.com/maria-lossevamalho/kids-sugar-and-behavioura_b_8482324.html

sugar vs. no sugar

sugar vs. no sugar only difference = parent behavior!

other substances might matter more

Kids with ADHD are nice kids!

but because they can be cute, and ‘zone in’…

Resources where you can learn more

.org

http://help4adhd.org/Understanding-ADHD/About-ADHD/Myths-and-Misunderstandings.aspx

Learner Objectives

the active participant will:

1.explain the reason ADHD is a disorder 2.describe how a clinician diagnoses

ADHD 3.define how ADHD symptoms impact a

child and family 4.debate ADHD issues

Today’s Timeline --- 90 minutes

• 5 min opening • 10 min ADHD challenges • 15 min ADHD biology • 20 min ADHD treatment • 20 min ADHD for AASC • 30 min debate club

Workshop: how can AASC members help?

debate and respond to these common comments

he can play his video game for hours!

what can you expect with all this sugar in our kids’ diets?

they just don’t raise kids right anymore

there’s way too many kids on these meds

ADHD is a just a label for normal, active children

all kids eventually grow out of it. adults don’t need medication!