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7/6/2011

Sit Still and Learn: ADHD Penny Corkum, PhD (Registered Psychologist) Associate Professor, Psychology Department Scientific Staff, IWK Health Centre Director of Research and Development, ADHD Clinic, CEHHA Presentation to: Academy in School Mental Health July 11-12 & 14-15, 2011

Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

Questions to be Answered What is ADHD? Is ADHD real or an excuse for bad behaviour? How is ADHD assessed and diagnosed? What are the common features of ADHD? H iis ADHD treated? How t t d? – Medication – School • Remediation • Accommodations Q&A Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

ADHD A rose by any other name would smell as sweet (Shakespeare)

Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

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7/6/2011

Current Diagnostic Criteria ADHD (DSM-IV) Three subtypes InA (6/9) HI (6/9) Combined (6/9 InA, 6/9 HI) Present in at least 2 settings S Symptoms t bbefore f age 7 Lasts longer than 6 months Developmentally inappropriate More frequent and severe Affects academic or social functioning Rule out other causes “The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder, and are not better accounted for by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder)

Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

ADHD Basics ADHD (3 subtypes) is diagnosed in ~5% of elementary school-aged children 65-80% of children diagnosed with ADHD continue to reach diagnostic criteria in adolescents (“lifespan disorder”) Changing symptoms of ADHD Inattention: Persists across time Impulsivity: Declines (but not normalized) Hyperactivity: Declines (but not normalized) Comorbidity is high and can change overtime Only 20% of children with ADHD have only ADHD! 40% have one other disorder, 30% two other disorders, 10% three + other disorders ADHD (and comorbidity) puts an individual at risk for social, academic, behavioural and work problems Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

ADHD – Is It Real?

Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

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7/6/2011

Biological Basis of ADHD Imaging (functional and structural) studies Differences in fronto-striatal networks

Behavioural Genetics Estimated at .80 80 (range .50 50 to .98) 98) No definite mode of inheritance has been established Most likely not a single gene locus, but rather polygenic Recent association studies implicate genes within the dopamine system in the etiology of ADHD Dopamine system innervates frontal-striatal circuits

Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

Assessment & Diagnosis

Not all that looks like ADHD is ADHD Or You can’t judge a book by its cover

Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

Assessment Rubric Kamphaus & Frick, 2002 Assess core symptoms and severity/impact Assess onset and developmental course Rule out alternative causes Rule in comorbidities

Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

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7/6/2011

Protocol Has To Include… Multiple assessment measures Standardized Testing Observation Interviews Informal Procedures

Data collected from multiple sources Home, School, Community

Multidisciplinary team Across institutions Mental Health, Health, Education Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

Problems with ADHD Assessments Over-reliance on questionnaires! Lack of differential diagnosis Co-morbid disorders not assessed Resulting in… Overdiagnosis Underdiagnosis Misdiagnosis Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

Role of Teachers in Diagnosis Do not diagnose or label …share your observations Help parents know how to access the diagnostic services they need & how to evaluate what comprises a good assessment Be an active participant in the diagnostic process Teachers are the best informants, so share all your knowledge with the psychologist or physician who is conducting the assessment

Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

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7/6/2011

Neurodevelopmental Framework

Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

Alexander Luria (1902-1977) Attention – 3 units Unit 1 – Arousal/Alertness Unit 2 - Processing Unit 3 – Executive functions

Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

Executive Functions in ADHD Brown, 2005 Executive Functions Activation

Focus

Effort

Executive Function Deficits

Emotion

Memory

Action

ADHD

Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

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7/6/2011

Neurodevelopmental Framework All Kinds of Minds Attention Higher Order Cognition Language Memory Neuromotor Functioning Social Cognition Spatial ordering Temporal Sequential ordering Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

Treatment

Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

Medication Effective in reducing core symptoms of ADHD BUT Doesn’t work with every child with ADHD P bl Problems with i h acceptance andd compliance li Side-Effects Reduces symptoms but does not improve adaptive functioning Not a remedy! Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

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7/6/2011

Solution Focus interventions on accommodation not remediation pp y not a Use medication as a window of opportunity long-term solution Teach the skills the child will need to be an effective learner and a full and productive participant in society Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

Educational Interventions Need a framework‌cannot intervene based on the label Each framework has strengths and weakness and knowing more than one is useful; however, however the framework you use needs to be geared to learning All Kinds of Minds provides an highly relevant framework for understanding, assessing and intervening with children who have attention and learning difficulties Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

Neurodevelopmental Framework All Kinds of Minds Attention Higher Order Cognition Language Memory Neuromotor Functioning Social Cognition Spatial ordering Temporal Sequential ordering Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

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7/6/2011

Attention Mental Energy Processing Controls Production Controls

http://www.allkindsofminds.org/ Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

Key Points Interventions need to be‌ Multifaceted I di id li d Individualized Proactive Collaborative (including the youth, school, home)

Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

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7/6/2011

Unsupported Treatments Dietary management (e.g., sugar, food dyes, etc.) Nutritional or dietary supplements (e.g., fatty acid) Homeopathic remedies Chiropractics Neurological treatments (e.g., biofeedback, sensory-motor integration training) Yoga, message, green outdoor settings Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

Youth Focus Groups Main Findings Couldn’t think of many good things about ADHD Mixed feelings about medication Not very knowledgeable about other treatments for ADHD Feel that others do not know about ADHD (“think you are stupid, lazy, crazy, bad”) Want others to know that …”they are not much different than others, teach us the way we learn, don’t expect us to make mistakes, don’t wait for us to mess up, treat us the same way as you treat others”)

Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

The Good Things To name a few … Spontaneity Creative Risk taker Not shy Multi- tasker Enthusiastic Fun…..

Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

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7/6/2011

Resources Online Resources All Kinds of Minds http://www.allkindsofminds.org/ TeachADHD http://www.aboutkidshealth.ca/teachadhd Misunderstood Minds http://www.pbs.org/wgbh/misunderstoodminds/ Totally ADHD http://totallyadd.com/ Canadian ADHD Resource Alliance http://www.caddra.ca CHADD Canada http://www.chaddcanada.org/

Local Organizations Learning Disabilities Association of Nova Scotia (902-423-2850)

Books and Videos ADD Warehouse http://addwarehouse.com

Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

QUESTIONS

“CHILDREN DO WELL IF THEY CAN. IF THEY CAN’T, WE AS ADULTS NEED TO FIGURE OUT HOW WE CAN HELP” (Ross Greene) Academy in School Mental Health Presented by: Sun Life Financial Chair in Adolescent Mental Health

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Penny corkum 3 slides(1)