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Attention deficitAttention Deficit
Hyperactivity Disorder: throughout the
Roland Rotz, Ph.D.
A lifespan neurobiological condition characterized by behavioral
difficulties in the areas of inattention, poor impulse control, and/or
hyperactivity impacting relationships and/or activities of daily living
such as work or school.
Presence of symptoms throughout lifespan.
Range of severity
Dimensional not categorical
Trouble with sustained attention, selective attention or poor
persistence of effort as seen in:
Listening in conversations
Remaining focused at work
Trouble with follow though on tasks
Loses things, forgetful
Difficulty with self-control in word or in deed as seen in the following:
Blurting out comments in conversations.
Trouble waiting your turn.
Trouble waiting in line.
Interrupting or intruding on others.
Overactivity in behaviors, thoughts and/or feelings as seen in the
Squirmy or fidgety with hands or feet
Difficulty remaining seated
Restless inside: antsy
Can’t turn your brain off.
Trouble calming down.
Activation: Organizing, Prioritizing & Activating to work
Focus: Focusing, Sustaining Focus & Shifting Focus to tasks
Effort: Regulating Alertness, Sustaining Effort & Processing Speed
Emotion: Managing Frustration & Modulating Emotions
Memory: Utilizing Working Memory & Accessing Recall
Action: Monitoring & Self-Regulating Action
Estimated.2-5 million kids in USA. 1 in every 25-30 children. 50% of child referrals to outpatient clinics. Once was 6/1 (m/f), now more 3/1. 50-85% continue to have symptoms as adults. 1 in every 30-35 adults. Boredom vs. Interest Sense of underachievement Difficulty getting organized Many projects going simultaneously Inconsistent work or school performance Impaired working memory Difficult transitions Often creative, intuitive, high IQ Impatient, frustration tolerance limited Self-esteem impaired Highly Genetic….80% heritability Maternal alcohol use: FAS Birth problems: Lack of oxygen Head trauma Weak arousal system, decrease in frontal lobe brain activity Neurotransmitter trouble: dopamine or norepinephrine or Child & Adult Clinicians, psychologists, MFCs, social workers Developmental Pediatricians, psychiatrists Some background and training in AD/HD Specific knowledge base for Adult ADD by attendance at Ask specific questions about diagnostic and treatment Clinical interview: Client plus significant other History: Developmental, health, school, drug, relationships and Review of school records: Grades & comments Behavior rating scales by self and others for presence and severity of AD/HD symptoms. Barkleys, BAADS, Wenders, Santa Barbara ADHD scales. Continuous Performance Tests: Conners or TOVA or Gordon. IQ testing: WISC-III, WAIS-III to clarify abilities and Cognitive & Learning abilities: W-J, WIAT, WRAT, KTEA, Bender, VMI to screen for LD like math, reading, memory deficits. Mood Disorders: Depression, bipolar, demoralized Anxiety Disorders: PTSD, GAD, O-C traits Behavioral Disorders: ODD, conduct, antisocial Addictions: Drugs, ETOH, gambling, shopping, food Learning Disabilities: Nonverbal LD,poor sequencing reading Neurological Disorders: Tics, FAS, head injuries Personality Disorders:Antisocial, Borderline Schizophrenia: EDUCATION: Become an expert on AD/HD. THERAPY: Range of types and issues. MEDICATION: Stimulants to Antidepressants COACHING: Who, How & What you need is most important. SUPPORT NETWORK: Local & National Support groups, newsletters, on-line services, family and friends. STRUCTURE BREVITY VARIETY SIMPLICITY PASSION BALANCE NUTRITION EXERCISE SLEEP Parent training and bibliotherapy Family and Individual therapy Small group therapy to improve self-esteem. Problem solving skill building. Anger and impulse control training. Homework management strategies. School & home behavior control skills. Develop coping strategies (bag of tricks) Grief: loss of time, persistence of condition Couples therapy: Resolve and reframe conflicts and struggles in Individual and/or group therapy: Rekindling hope for work, Treating comorbid conditions in combination with AD/HD. Medication efficacy monitor. Where’s the Hope? Structure, Direction Reassurance Feelings identified Not open-ended exploring Not free association Non-neutral as a therapist. Active style: Give some directions, explore others. Use of visual aids such as: marker board Recognize movement or fidgeting may be helpful for them to focus. Appropriate advocating for workplace or educational needs. MEDICATIONS
Effect seen in 1-4 days
Typical effects: Increased focus, less activity & impulsivity
Side effects: Decreased appetite, dry mouth, nausea, headaches, tics,
SSRIs & Tricyclics:
Zoloft (Sertraline) Paxil (Paroxetine) Welbutrin (Bupropion) Imipramine Desipramine Effect in 2-4 wks. Typical effects: Better modulated affect, better concentration, good impulse control. Side effects: Insomnia, reduced libido,fatigue, agitation,tremors, and dry mouth in Stimulants vs. Addictions?
Proper stimulant medication use doesn’t lead to drug abuse in ADHD adults may feel focused while others feel restless. Detox, medicate, and monitor effects closely. Watch for losing pills, overuse, hiding use, no response to any No guidelines, use your knowledge/intuition ADHD: Support Systems
Dyslexia Awareness Resource Center 963.7339 Monthly support group Contact: Joan Esposito Colleges & Universities usually test for LD not ADHD Local therapists and coaches offer services. SBCC Adult Education classes ABOVE ALL.
AD/HD IS A REASON,
NOT AN EXCUSE!
Thank you for your sustained attention!
Roland Rotz, PhD
CURRICULUM VITAE 1962 Graduated Elementary and High School in Givatayim, Israel. Attended Hebrew University-Hadassah Medical School, Jerusalem, Israel. M.D. Degree, Hebrew University-Hadassah Medical School. Served in Medical Corps, Israel Defense Forces. Resident in the Department of Anesthesiology, Intensive Respiratory Unit and Instructor at the Hebrew University-Hadassah Me