Transcript Fetal Alcohol Spectrum Disorder (FASD)

ADHD
• Inattention
• Hyperactivity
• Impulsivity
DSM-IV Criteria
A.Either (1) or (2)
1. 6 or more symptoms in Inattention
2. 6 or more symptoms of Hyperactivity-Impulsivity
– Symptoms present for at least 6 months
B.Significant impairment in social, academic, or
occupational functioning
C.Onset prior to 7 years of age
D.Impairment in two or more settings
Comorbid conditions in ADHD
Comorbidities
Anxiety Disorder
Conduct Disorder
Oppositional Defiant Disorder
Tic Disorders
Depressive Disorders
Mania/Hypomania
% Range
8-30
8-25
45-64
8-34
15-74
0-22
Rothenburger et al., 2004
• ADHD occurs in 2-5% of children
• 80% are boys
• Distractibility, hyperactivity, and agitation occur at
all ages
• Forgetful, inpatient, disrupt others
• Difficulty with limits, impulsivity
• Rash decisions, don’t think before they act, silly,
mood swings
• Do better in novel situations that involve interaction
with others
Causes of ADHD?
• Brain areas affected
– Cerebellum: coordination of movements
– Frontal lobe: executive functioning
• Difficulty with neuronal information processing
• Lower levels of dopamine (emotion and behavior)
• Genetics: runs in families
– 80% can be traced to genetic factors
– Genes involved in transferring information b/w neurons
• Environmental factors
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Prenatal alcohol and nicotine exposure
Non-supportive school environment
Martial crisis and parental psychological problems
Poor attachment
Medication and ADHD
• Target neurotransmitter systems
– Psychostimulants: Ritalin
• Medication most effective when combined with
behavior therapy
• Large US study compared different treatments
methods among 579 children with ADHD
• Significant improvements (normalized behavior):
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Medication only: 25%
Behavior therapy only: 34%
Medication with counseling: 56%
Medication and behavioral theory: 68%
ADHD
• Important to teach children with how to handle
tasks and their behaviors
• Count to 10, reminders etc.
• Children with ADHD have many positive traits:
– Free-spirited, inquisitive, energetic, funny
– Intelligent, creative, spontaneous, helpful,
sensitive
– Multi-tasking
Sherman et al., 2006
Some ADHD behaviors are adaptive
• Impatient, impulsive, distractible, energetic,
emotionally needy, creative, innovative
• Many historical figures show ADHD characteristics
– Einstein, Poe, Salvador Dali, Ford
• Hartmann (2003) refers to ADHD as a trait rather
than a disorder (Edison gene)
• These traits were advantageous for huntergatherer societies and have been passed down
over time
• Short attention, poor planning, daydreaming, and
impatience may be seen as adaptive
• Important for survival of hunter-gatherer societies
– Agile, think quickly, monitor environment, act on impulse
• Farmer societies are more patient, organized, plan
ahead, less impulsive
• However, North American classrooms favor farmer
like traits
– Children must sit in desks quietly, pay attention, work on
projects for prolonged periods of time, keep hands still,
information taken in by reading, listening, and seeing
rather than by doing.
• Children with ADHD seen as polyactive, they can
work on numerous tasks
• Good brainstormers, eager to please, creative
• Suggestions for Classroom Interventions:
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Allow children with ADHD to run class errands
Have quiet zones, one-on-one interaction
Call on students frequently, use immediate feedback
Teach to all different intelligences
Hands on lessons, experiments, visual media, arts
Break down instruction to smaller manageable tasks
Assist with organization, external structure
Avoid mundane tasks
Wang et al. (2004)
• Impact of teacher factors on performance of
children with ADHD
• Participants: 45 7.5 yr old boys with ADHD
– all on ADHD medication, from 12 different after
school programs
• Children solved puzzles in 3 conditions/modalities:
– Speech only
– Gesture only
– Speech and Gesture
• 12 trained male teachers (one from each program)
• Condition order was random, and videotaped
• Dependent variables: (in each condition)
– Freq. of children’s responses to teachers
– How long children sustained their attention
– Success on puzzles
• 5 coders independently coded the tapes, 90%
agreement
• Also examined different types of gestures within
the gesture conditions
Results
• Children in Gesture conditions (gesture-only or
speech-gesture) were:
– more responsive
– focused longer
– more successful on puzzles
• Conclude that hand gestures are important for use
with children with ADHD.
• Children with ADHD have attention problems and
are easily distracted, so speech alone may not be
sufficient to get their attention.
Limitations? Confounds?