Transcript Slides - KU Mini College

1
WELCOME BACK TO KU!
2
PRESENTED BY
Robert G. Harrington, Ph.D.
Department of Psychology and Research In Education
KU School of Education
630 J R Pearson Hall
University of Kansas
Lawrence, Kansas 66047
[email protected]
3
MY BACKGROUND
•
I have been a Professor in the PRE Dept . of the SOE for the past 34 years.
•
I teach graduate and undergraduate courses in the program in Development and
Learning.
•
Among the courses that I have taught are included, Theory and Research in
Intelligence, Classroom Management, Diagnosis and Treatment of Oppositional Defiant
Disorders, Attention Deficit Disorders in Children and Adults, Bullying Prevention and
Intervention, Behavior Problems and Personality Assessment, Social Skills
Development in Children and Adults, Human Development Across the Lifespan.
•
Currently, I am working on an online certification program to prevention and intervene
in cases of bullying
•
I regularly provide inservice training to schools, mental health agencies, hospitals and
professional groups on the topic of ADD/ADHD and related topics
•
Just completed keynote presentations at Irish International Conference on Education
and at Nebraska Autism Disorders Conference
4
DESCRIPTION OF MY PRESENTATION
 It is conservatively estimated that 5 to 6 percent of school-age children will have
attention deficits while in school but what happens to them when they graduate
from school? Do their attention deficits just disappear and go away? We just don’t
hear much about adults with attention deficits. Are they successful in their lives, in
their work, in their relationships? How can someone tell if they have attention
deficits as an adult? What can be done to manage and cope with attention deficits
in adulthood? What could happen if you are in a relationship with someone with
attention deficits? Are there happy endings? The purpose of this mini-course is to
explore attention deficits and their effects in adult life.
5
OBJECTIVES OF THE PRESENTATION
•
Two relevant cases of Adult ADD
•
Can you spot the myths?
•
What does ADD in Adulthood look like?
•
How is it diagnosed?
•
What are the effects of Adult ADD on personal/ emotional development?
•
What are the effects of Adult ADD on marital and social relationships ?
•
What are the effects of Adult ADD in the workplace?
•
What can be done to help?
•
Questions/Answers
6
TWO RELEVANT CASES OF ADULT ADD
1. Grad Student in Learning Theory Course
2. Teacher attending a workshop on Childhood ADHD speaks up about her husband
at the break
7
CAN YOU SPOT THE FACTS VS. MYTHS?
1. ADD/ ADHD in Adults is just a lack of willpower.
2. Everyone has the symptoms of ADD/ADHD and anyone with adequate intelligence can
overcome these difficulties on their own.
3. Someone cannot have ADD/ADHD and also have depression, anxiety, or other
psychiatric problems
4. Unless you have been diagnosed with ADD/ADHD as a child, you cannot have it as an
adult.
5. ADD/ADHD always requires medication.
6. It is not uncommon for individuals with adult ADD to seek out relationships with others
with social skills strengths that complement their deficits
7. Disorganized physical environments tend to increase the ADD symptoms
8. Men have more ADD than women
9. In the West we diagnose more ADD/ADHD than anywhere else in the world
10. Kids mostly grow out of their ADD symptoms with age.
8
ADULT ATTENTION DEFICIT DISORDER
Also referred to as:
Adult Attention Deficit Hyperactivity Disorder (Adult ADHD)
Adult ADD or AADD
NOTE: Adult Attention Deficit Disorder is the term used to describe the
neuropsychiatric condition attention deficit hyperactivity disorder when it is
present in adults.
•
Up to 60% of children diagnosed with ADHD in early childhood continue to
demonstrate notable symptoms as adults.
•
It is estimated that 5% of the global population has ADHD (including cases not
yet diagnosed).
9
WHAT DOES ADULT ADD LOOK LIKE?:
IDENTIFICATION AND CLASSIFICATION
DSM-IV TR or the Diagnostic and Statistical Manual of Mental Disorders, 2000, ed.
defines three types of disorder:
1) Inattentive type
2) Hyperactive/impulsive type
3) Combined type
To meet the formal diagnostic criteria, an individual must display
at least 6 inattentive symptoms for the inattentive type
at least 6 hyperactive symptoms for the hyperactive/impulsive type
all of the above to have the combined type
Note: DSM V is coming out soon! Symptoms are similar to these…..
10
SIGNS AND SYMPTOMS-INATTENTION
IN CHILDREN:
Forgetful during daily tasks
Easily distracted
Losing important items
Not listening and not responding to name being called out
Unable to focus on tasks at hand; cannot sustain attention
Avoids tasks requiring tasks sustained mental effort
Makes careless mistakes by failing to pay attention to details
Difficulty organizing tasks and activities
Fails to follow through on complex instructions and tasks
11
SIGNS AND SYMPTOMS-INATTENTION
IN ADULTS:
Procrastination
Indecision, difficulty recalling and organizing details required for a task
Poor time management; losing track of time
Avoiding tasks or jobs that require sustained attention
Difficulty initiating tasks
Difficulty completing and following through on tasks
Difficulty multitasking
Difficulty shifting attention from one task to another
12
SIGNS AND SYMPTOMSHYPERACTIVITY/IMPULSIVITY
IN CHILDREN:
Squirms and fidgets (with hands and/or feet)
Cannot sit still
Cannot play quietly or engage in leisurely activities
Talks excessively
Runs and climbs excessively
Always on the go, as if “driven by a motor”
Cannot wait for their turn
Blurts out answers
Intrudes on others and interrupts conversations
13
SIGNS AND SYMPTOMSHYPERACTIVITY/IMPULSIVITY
IN ADULTS:
Chooses highly active, stimulating jobs
Avoids situations with low physical activity or sedentary work
May choose to work long hours or two jobs
Seeks constant activity
Easily bored
Impatient
Intolerant to frustration; easily irritated
Impulsive, snap decisions and irresponsible behaviors
Loses temper easily, angers quickly
14
CLINICAL EVALUATION OF ADULT ADD
Find out what prompted the individual to make an appointment at this time
Have the client complete some questionnaires before the initial visit
Discuss the medical background, work history, home history, family relationships with
the client
Are the client’s conditions being worsened by some condition other than ADD? A
medical problem? A Psychiatric problem? Stress? Sleep disorder? Alcoholism?
Asperger’s? Autism? Learning Disability, Dyslexia, Hearing Disorder?
Developmental Disorder?
ADD is diagnosed if:
No other cause for the client’s symptoms can be found
The person has a long history of such symptoms
The symptoms are severe enough to cause significant in function or relationship
15
ADULT ADD FACTS
Adults with ADD have a deficiency in executive cognitive functioning; resulting in deficiencies in
self-regulation, self-motivation, distractibility, procrastination, organization and prioritization.
Adults with ADD are average to above average in intelligence
Adults with ADD experience a chronic condition that requires coping skills
Adults with ADD experience significant effects on education, employment and interpersonal
relationships
Employers, spouses and friends often fail to see the signs of Adult ADD; symptoms change with
maturity
Adults are far less likely to evidence traditional hyperactivity symptoms
Adults with ADD are more likely to have car accidents, less education, less professional
development
Adults with ADD often compensate for the need for high stimulation by smoking, taking alcohol or
illegal drugs
Adults with ADD often have comorbidities such as depression, anxiety, substance abuse, learning
disabilities, dyslexia; up to 80% will have some comordbidity
16
CAUSES OF ADULT ADD
Specific causes are unknown
Speculations:
Genetics – Twin studies show that Adult Add is highly inheritable; 75% of cases
Evolutionary Theory – (Hunter V. Farmer Theory) ADHD may have been adaptive
Environmental Theory – alcohol and tobacco exposure during pregnancy, exposure to
lead, premature birth, low birth weight, maternal infections during pregnancy,
exposure to pesticides
Diet – Food coloring such as red dye #40; no evidence for sugar or caffeine
Social – Disorganized family life or educational experience, attachment disorder and
trauma, foster care, internationally adopted children, sensory integration
dysfunction
17
CAUSES CONTINUED
Neurodiversity: Issue of emotional tolerance and behavioral tolerance
Social Construct theory of ADHD: Thomas Szasz, “ADD was invented and not
discovered.”
Low Arousal Theory: Excessive activity is needed to compensate for low arousal;
require environmental stimuli to pay attention; if not enough stimulation then the
adult creates their own stimulation
Pathophysiology: Frontal lobe, left temporal lobe, cerebellum, dopamine neural
transmission
18
QUESTIONNAIRES TO ASSESS ADULT ADD
Adult ADD History Questionnaire – Client’s personal and family psychological history
Adult ADD Medical History Questionnaire – Medical issues related to the diagnosis
Adult ADD Symptoms Questionnaire – Client symptoms related to ADD
Available at AdultADD.Info
19
DIAGNOSTIC AND BEHAVIORAL
SYMPTOM QUESTIONNAIRE
Scoring Key: Answer how well each statement describes you when you don’t use
special aids or tricks you have developed to get around or compensate for
difficulties you might have. Score each answer as follows:
0. Doesn’t describe me at all
1. Describes me somewhat or some of the time
2. Describes me pretty well or most of the time
3. Describes me very well or almost all the time
20
Initiation
I have trouble getting started doing things.
Completion
I have trouble completing things
I dislike tasks that require a long series of steps
Execution
I don’t do tasks efficiently ( a good job in a short time)
It is hard for me to do two or three tasks in a row
I do not always do what needs to be done
21
Distraction
I am easily distracted by things I hear or see even when I am trying to concentrate
I get distracted by my own thoughts
Perseverance and Focus
I have trouble doing tasks that require keeping my attention on them for along period
of time
I often switch from doing one thing to another even when I don’t have to.
I have trouble keeping my attention on one task.
Inattentiveness
I don’t pay attention when I should, make careless mistakes
I have trouble listening while others speak to me
22
Memory
I get so deeply into one thing that I forget others
I lose or misplace things
I have trouble being on time
I forget appointments
I am often late for appointments
Future Awareness and Planning
I have trouble making plans long in advance
I rarely get to trains at least 10 minutes early
23
Consider a diagnosis of Adult ADD if:
A person’s average score on these 34 questions is 2 or higher and
The symptoms significantly impair the person’s work, school, family, or personal
activities and
The person experiences significant stress from the effects of the symptoms and;
There is no other medical or psychological explanation for them
24
PERSONAL AND FAMILY ADD HISTORY
Childhood History of ADD
Explain , if necessary
As a child, I ….
--- Had to repeat one or more grades_______________
__Fidgeted a lot, couldn’t sit still__________________
__Was distractible, had a short attention span________________
__Had a lot of discipline problems________________
__Never did as well as I should have in school________________
__Was treated for ADD
25
Adult History Related to ADD
__I have been diagnosed as having ADD
__I have been treated for ADD
__I have been given one or more tickets for speeding
__I was driving a car when it was totaled
__I have been in one or more “fender benders”
__I think so much that I have trouble getting to sleep
__I have to change jobs often (been fired)
__I have had periods when I overspent
__I have had periods when I gambled too much
26
__I have had periods when I was overactive physically
__I have had periods when my mind raced
__I need a lot of caffeine to get going at the start of the day
__I have been hospitalized for a psychiatric disorder
Family History
__I believe that a blood relative had/has ADD
__A blood relative was given the diagnosis of ADD
__A blood relative has taken medication for ADD
__I have a blood relative who has manic-depressive (bipolar ) illness
27
ADULT ADD RELATED MEDICAL HISTORY
Medical Issues
Thyroid problems (which)?
(Thyroid problems can mimic ADHD. Both thyroid meds and stimulants can cause
weight loss)
Glaucoma?
(Stimulants can increase eye pressure in people with narrow angle glaucoma
Seizures?
(stimulants may cause seizures in people who have already had them
Been knocked unconscious
(Brain injury mimic ADD or make it worse)
28
Liver problems
(Many medications are metabolized in the kidneys. Some medications, like Strattera, may
cause liver problems.
Reynaud’s
(Stimulants can make Raynaud’s worse or cause it (cold and white or blue fingers or toes)
Heart Problems
(Stimulants are contraindicated in people with heart problems, Very rare deaths from the
use of stimulants have been associated with a history of structural heart disease or
cardiac dysrhythmias)
Migraines, if so, what medication do you take from them, if any?
(Stimulants may increase blood pressure, An increase in blood pressure medication may
be required by patients taking stimulants or Wellbutrin (buproprion)
29
What is your blood pressure? When was it last taken?
(Bring blood pressure down to normal before starting stimulants)
Is your pulse less than 50 per minute when resting?
(May need cardiac work-up unless low pulse is from good physical conditioning)
Is your pulse more than 95 per minute when resting?
Stimulants can further increase the pulse and are contraindicated in people with pulse this
rapid
Did a blood relative die at an early age of heart problems?
(This may be a contraindication to taking stimulants since this fatal vulnerability may be
genetic
Do you have twitches or tics
(Tics or twitches may be made better or worse by stimulants
30
Sleep
Do you have sleep apnea?
(Sleep apnea may cause ADD like symptoms or make ADD worse)
If so, what evaluation or treatment have you had for sleep apnea?
A sleep study may be indicated for t hose with major sleeping problems. If a person is
using CPAP, are they using it regularly with good effect?
Do you have difficulty falling asleep?
(May be due to sleep apnea or depression)
Difficulty staying asleep?
(May be due to sleep apnea or depression)
31
Find yourself tired during the day, yawning a lot?
(These symptoms may be caused by sleep apnea, Overtiredness may make ADD
symptoms worse or mimic ADD)
Do you nap at least a few times a week to stay alert?
(This may be a sign of sleep apnea)
Do you awaken during the night feeling frightened?
(This may be a sign of sleep apnea)
Do you snore?
Slightly suggestive of sleep apnea
Have you been observed to stop sleeping during sleep, and then awaken with a start?
This is a symptom very suggestive of sleep apnea
32
Medication Reactions
Are you allergic to a medication (Medication? Reaction?)
Do you take an MAOI antidepressant medication?
(Stimulants and SSRIs are contraindicated in persons taking MAOIs
Diet Supplements
Do you take fish oil?
(This may be mildly helpful to people with ADD but good research support for this is
still lacking)
Vitamin C?
This decreases the absorption and increases the excretion of amphetamines and
thereby reduces it effect
33
Do you take an herbal medicine? If so, which?
(There are some interactions with stimulants)
Do you take over the counter medications? (which)?
(Aspirin taken at the same time as stimulants can reduce the absorption of stimulants.
OTC medications containing ephedrine or pseudoephedrine can make the cardiac side
of stimulants worse)
Substance History
Have you been addicted to or abused drugs?
(Persons with such a history may require more careful oversight if stimulants are
prescribed)
Have you used “speed” or uppers (Dexedrine or others)?
(People’s previous experience taking these medications can suggest how they will respond
now)
34
Have you ever taken a stimulant? What effect did it have on you?
(A person’s reaction to stimulant medication taken in the past may predict his or her
response to its therapeutic use)
Drugs/Alcohol
Do you smoke marijuana fairly regularly?
(Marijuana often interferes with the use of medications for ADD)
Do you smoke cigarettes or cigars? (How many per day?)
People with ADD find it harder to stop smoking. It is possible that successful treatment of
the ADD may make it easier to stop. Buproprion, which of some help to some patients
with ADD, is a fairly good smoking cessation aid)
Do you smoke caffeinated drinks (if so, how much per day?)
(Caffeine may worsen some of the side effects of stimulants like difficulty sleeping,
headache, and atrial fibrillation)
35
Do you have at least one drink almost every day? (How many?)
(Alcohol can interfere with the effects of stimulants)
Have you sometimes had too much alcohol to drink?
People taking stimulants may be less likely to realize when their judgment and
reflexes are impaired by alcohol. This may make driving more dangerous.
Is there someone in your home who has abused drugs or who might use drugs
prescribed for you?
(If this is so, the patient, must be very careful to keep the stimulant medication in a
secure place where it will not tempt the other person in the home to use it.
Females only
Are you pregnant or planning to get pregnant?
(Stimulants may adversely affect fetal development)
36
Are you using protection against getting pregnant?
(Such protection will reduce the concern about the need for stimulants during
pregnancy)
Are you breast feeding or considering breast feeding?
Stimulants are carried in breast milk and may adversely affect the infant
37
Have you ever taken a stimulant? What effect did it have on you?
(An individual’s reaction to stimulant medication taken in the past may predict his or
her response to its therapeutic use)
Drugs/ Alcohol
Do you smoke marijuana fairly regularly?
(Marijuana often interferes with the use of medications for ADD)’
Do you smoke cigarettes or cigars (How many per day?)
(People with ADD find it harder to stop smoking. It is possible that successful
treatment of the ADD may make it easier to stop. Buproprion, which of some help
to some patients with ADD, is a fairly good smoking cessation aid)
Do you drink caffeinated drinks (if so, how much per day?)
38
Organization
I get disorganized
I have trouble organizing tasks
My personal work area is messy
I don’t prioritize or plan my day
I can’t work well without structure or direction
I waste a lot of time doing nothing
Physical Activity (Hyperactivity)
I need to keep walking, moving around
I have trouble sitting still, I fidget
39
Frustration/Impulsiveness
I am easily frustrated
I get impatient easily
I interrupt when other people are talking
Anxiety
I focus and concentrate better if I am somewhat anxious
Multi-Tasking
I often try to do more than one task at a time
I tend to make things more complicated than they need to be
Sleep
I have trouble getting to sleep because my mind is going
40
DIAGNOSIS OF ADULT ADD
Entirely clinical and therefore controversial!
Were the symptoms present in childhood?
Get corroborating evidence from family members
Get corroborating evidence from school records
Get corroborating evidence from employment history
Get corroborating evidence from medical history/family tree
Neuropsychiatric evaluation to determine:
intelligence
general knowledge
self-reported ADD symptoms
tests to screen for co-morbid conditions
41
NOTE CAREFULLY
Every normal individual may exhibit ADD or ADHD like symptoms occasionally (e.g.,
when tired or stressed) but for the ADULT ADD diagnosis:
Symptoms should be present from childhood
Symptoms should persistently interfere with functioning in multiple spheres
Symptoms from childhood are manifested in adulthood but in perhaps a different
manner
42
TREATMENT OF ADULT ADD
Self – Help
Exercise and eat right
Get plenty of sleep
Practice better time management
Work on your relationships
Create a supportive work environment
43
IN GENERAL: TREATMENT AND THERAPY FOR
ADULT ADD
Talk Therapy
Marriage and Family Therapy
Cognitive Behavioral Therapy
Job Coaching
Social Skills building
Medical Treatment
Self-Management
Modification of the Physical Environment
Development of Support System
Positive Attitude; take advantage of personal skills
44
SUPPORT GROUPS FOR ADULT ADD
Purposes for support groups:
Reduces the isolation of struggling alone with the disorder
Gives you a place to express your feelings among others who may understand
Lets you share strategies for success
45
BEHAVIORAL COACHING
Goal: Practical solutions to problems in everyday life; not a substitute for therapy
Prioritizing
Motivation
Time Management
Procrastination
Organization
Impulse Control
Distraction Reduction
46
INTERVENTIONS
SELF
Relationships
Workplace
47
EFFECTS OF ADULT ADD ON THE INDIVIDUAL
Messages received by adults with ADD:
•
I am a fraud and others will find out
•
If only I would try harder
•
My way of doing things is wrong
•
I am lazy
•
Just do it like everyone else
•
I just can’t follow the conversation and I interrupt
•
I resent the criticism I get from others
•
I just don’t seem to know what is socially appropriate
48
WHAT IS AN ADULT WITH ADD TO DO?
1.
Accept yourself
2.
Be realistic about what you can do
3.
Set goals and celebrate accomplishments
4.
Understand your limitations and plan for them
5.
Anticipate your needs
6.
Get a schedule book
7.
Allow for de-stressing time
8.
Plan a meeting with your spouse to figure out you both are doing
9.
Recognize that partners need respite too
10. Don’t overcommit
11. Know when to say, “NO” and do not overcommit
12. Rearrange your environment
13. Do things your way as long as it does it does not irritate or affect others
14. Get knowledge about Adult ADD and seek medical help if necessary
49
WHAT DOES AN ADD/ADHD MARRIAGE LOOK
LIKE?
Spouses report: My husband or wife constantly forgets, misses appointments. I
feel like I am raising another child? I can never count on my spouse. It goes from
feeling responsible for everything to chronic anger. I did not like the person I had
become either. I have 100% of the family responsibility.
Symptoms:
“Do you hear what I am saying?”
“You never help me around the house”
“You are so unreliable”
“How could you forget to pick up our son from school again?
“You know we can’t afford that new computer you just bought”
“Help, my partner does not seem motivated to change”
50
WHAT IS A COUPLE TO DO? WHAT GETS IN THE
WAY?
Transition from hyperfocus dating to marriage or committed relationship
Walking on eggshells
Believing ADD/ADHD does not matter
Misinterpreting symptoms
Chore wars
51
WHAT IS A COUPLE TO DO? (CONTINUED)?
Impulsive Responses
Nag now, Pay later
The Blame Game
The Partner-Child Dynamic
Difficulty listening and paying attention
Create routines and procedures
Understand Emotional Overreaction and How to Deal with It
Make to-do lists
Get organized
Get partner to repeat requests
Understand the preferred channel for interaction: Verbal, Auditory, Pictorial etc.
52
WORK ON BETTER COMMUNICATION BY:
Eliminating distractions
Make good eye contact
Take a time out
Learn to compromise
53
ADD CAN BE A JOB KILLER….
FACTS:
Adults with ADD earn $4300 less per year than others in the same position
Adults with ADD are often underemployed or unemployed
Adults with ADD are viewed by employers as underachievers
54
WHAT TO DO ON THE JOB
End Distractions
Aha distractions: make lists
Oh no distractions: make a plan
Ho-hum distractions: set realistic deadlines and take breaks
Schedule more time to complete a task than really necessary
Modify the work environment
When and where do you work best?
55
ADD AND THE LAW:
WHAT CAN AND SHOULD AN EMPLOYER DO?
Title I of the Americans with Disabilities Act of 1990 prohibits all employers with 25 or
more employees (15 or more prior to July 1994) from discriminating against
individuals with disabilities who are otherwise qualified in the application, hiring
firing, advancement and other conditions of their employment
Adaptations and Accommodations:
Short Attention Span: Change the schedule
Distractibility: Make quiet work places
Hyper-focusing: Break jobs into manageable chunks and monitor completion
Hyperactivity: Short work breaks should be scheduled throughout the day
Memory: Put it in writing
Time Management: Make a habit of arriving 15 minutes early
Over commitment/Procrastination: Get progress reports
56
Social Skills:
Work on communication, social contact
Leadership style compatibility: Its all about Competence and Commitment
Directive
Coaching
Supportive
Delegative
57
RESOURCES
ADDA (Attention Deficit Disorder Association) www.add.org
National Resource Center on ADHD, www.help4 adhd.org
58
59
QUESTIONS AND ANSWERS
60