ADHD a Neurobiological Condition is related to SLD

ADHD a Neurobiological Condition is related to SLD
Attention Deficit Hyperactivity Disorder (ADHD) - with Inattention and/or Impulsivity
Specific Learning Disability (SLD) - with Auditory, Visual or Kinesthetic Processing Problems including Dyslexia/Reading Disorder

Other Neurobiological Conditions Related to ADHD:
Central Auditory Processing Disorder (CAPD)
Sensory Integration Disorder
Motor Planning Disorder
Self-Regulatory Disorder
Autistic Spectrum Disorder - PDD, MSD, Globally Delayed, Autistic
Neurological Conditions: Epilepsy, Tourette Syndrome

What Research is Telling Us about ADHD
Genetically transmitted in 70-95% of cases
Results from chemical imbalance or deficiency in certain neurotransmitters-chemicals which help brain regulate behavior
Rate at which brain uses glucose, its main energy source, is lower in subjects with ADHD than those without (Zametkin et al, 1990)
Depressed release of Dopamine might have role in ADHD (Volkow et al, 2003)

Research also tells us about ADHD that:
Central pathological deficits of ADHD are linked to several specific brain regions
Frontal Lobe
Its connections to Basal Ganglia
Their relationships to central aspect of Cerebellum
Less electrical activity in brain & show less reactivity to stimulation in one or more of above brain regions
Brains are 3-4% smaller-in more severe-frontal lobes, temporal gray matter, caudate nucleus & cerebellum were smaller

PET Scan of Metabolism of Glucose Adult Brain with ADHD
Positron Emission Tomography (PET) Pictures of
Adult with ADHD Normal Adult

ADHD & LD lead to Diminished Executive Functions
Deficient self-regulation of behavior, mood, response
Impaired ability to organize/plan behavior over time
Inability to direct behavior toward future
Diminished social effectiveness & adaptability

What is the Impact of these Disorders?
Neurologically based behavioral issues can keep child from developing normally
Lack of full coordination of gross & fine motor skills
Lack of complete age appropriate speech, language & communications
Impaired self-esteem

What is the Extent of ADHD?
About 3% of school-aged population have full ADHD symptoms & another 5-10% have partial ADHD
Another 15-20% of school-aged population show transient behaviors suggestive of ADHD
Boys are 3 times more likely than girls to have ADHD
Symptoms decrease with age but 50-65% of children still manifest symptoms into Adulthood (Korn & Weiss, 2003)

What is the Extent of SLD?
15% of Americans have learning disabilities with many going untreated due to lack of diagnosis
10 million children or approximately 1 in 5 children in 1st through 9th grades (Cramer & Ellis, 1996)
60% of adults with severe literacy problems have undetected/untreated LD (NALLDC, 1994)

What is the Impact of ADHD on people? (Barkley, 2002)
32-40% of students with ADHD drop out of school
Only 5-10% will complete college
50-70% have few or no friends
70-80% will under-perform at work
40-50% will engage in antisocial activities
More likely to experience teen pregnancy & sexually transmitted diseases
Have more accidents & speed excessively
Experience depression & personality disorders

What is the Impact of these Disorders?
35% of students with learning disabilities drop out of school
30% of adolescents with learning disabilities will be arrested 3 to 5 years out of High School (Wagner et al, 1993)
Previously undetected learning disabilities have been found in 50% of juvenile delinquents - Once treated their recidivism drops to just 2% (Lerner, 1997)

Attention Deficit Hyperactivity Disorder
Inattention - Traditionally known as ADD
Impulsivity - Traditionally known as Hyperactivity

ADHD Characteristics
Inattention
Impulsivity
Overactivity

Inattention-Distractibility
Doesn’t seem to listen
Fails to finish assigned tasks
Often loses things
Can’t concentrate
Easily distracted
Daydreams
Requires frequent redirection
Can be very quiet & missed

Impulsivity-Behavioral Disinhibition
Rushing into things
Careless errors
Risk taking
Taking dares
Accidents/injuries prone
Impatience
Interruptions

Hyperactivity - Overarousal
Restlessness
Can’t sit still
Talks excessively
Fidgeting
Always on the go
Easy arousal
Lots of body movement

Different Names for ADHD Through the years:
1902 Defects in moral character
1934 Organically driven
1940 Minimal Brain Syndrome
1957 Hyperkinetic Impulse Disorder
1960 Minimal Brain Dysfunction (MBD)
1968 Hyperkinetic Reaction of Childhood (DSM II)
1980 Attention Deficit Disorder - ADD (DSM III) with-hyperactivity without-hyperactivity residual type

Names for ADHD
1987 Attention-Deficit Hyperactivity Disorder or Undifferentiated Attention Deficit Disorder (DSM III-R)
1994 Attention-Deficit/Hyperactivity Disorder (DSM IV) 314.01: ADHD, Combined Type 314.00: ADHD, Predominantly Inattentive type 314.01: ADHD, Predominantly Hyperactive-Impulsive Type

What is Learning Disability?
Definition:
A learning disability is a disorder that affects a person’s ability to either interpret what is seen and heard or to link information from different parts of the brain. These limitations can show up in many ways - as specific difficulties with spoken and written language, coordination, self-control, or attention. Such difficulties extend to school work and can impede learning to read or write or do math.

What are Learning Disabilities
Neurological in origin
Impede person’s ability to store, process or produce information
Affect ability to read
Affect ability to speak
Affect ability to compute math
Impair socialization

LD Language Symptoms
Pronunciation problems
Slow vocabulary growth
Lack of interest in stories
Poor spelling
Delayed decoding
Poor reading comprehension
Trouble following directions
Lack of verbal participation in class

LD Memory Symptoms
Trouble learning numbers, alphabet & days of the week
Slow acquisition of new skills
Poor memory for routines
Slow recall of facts
Organizational problems

LD Attention Symptoms
Trouble sitting still
Extreme restlessness
Impersistence at tasks
Impulsivity
Inconsistency
Poor self-monitoring, insatiability
Great knowledge of trivia
Careless errors

LD Fine Motor Skill Symptoms
Trouble learning self-help skills
Clumsiness
Reluctance to draw, trace or color
Poor pencil grasp
Poor letter formation
Fist-like or tight pencil grasp

Cognitive, Speech & Language, Motor, Sensory & Motor Planning
Pediatric Psychologist
Speech & Language Pathologist
Occupational Therapist - sensory integration
Physical Therapist

Medication Treatment of ADHD
STIMULANTS
Ritalin -one dose lasts up to 4 hours
Metadate – Ritalin – once a day lasts up to 12 hrs
Focalin – New Ritalin derivative lasts up to 4 hours
Attenade -Newest Ritalin derivative-lasts 6 hours
Concerta - once a day lasts up to 12 hours
Dexedrine -last 4 hours-spansule lasts 10 hours
Adderall - New Dexedrine - once or twice a day lasts longer than Ritalin
Cylert -requires liver function testing due to history of hepatic failure with children who were on it

Medication Treatment of ADHD
Non-Stimulant Medication:
Strattera – acts as a stimulant with similar side affects – norepinephrine reuptake inhibitor – not to be used with Prozac, Paxil or albuterol
Nutraceutical:
Attend - a natural product which combines amino acids, fatty acids, lipid complexes, homeopathic medicines, hormone precursors to specific neurotransmitters

Plus these interventions:
Parent Team
Home Modifications
Parent-Teacher Team
504 Plan with Educational
Consistency of parent-teacher-doctor team
Unconditional love from all adults
Classroom Modifications for Students with ADHD & SLD
1. Classroom Modifications
Establish rules in classroom
Reinforce rules in classroom
Be consistent
Interact with student by: eye contact, call name, finger on desk, touching
Place student: in front, near positive peers, in low distracting areas
2. Classroom Modifications
Evaluate & structure environment
Reduce external visual & auditory stimuli
Repeat & have student paraphrase directions
Give short directions
Use predetermined signals
Multiple modalities
3. Classroom Modifications
Natural & logical consequences
Develop learning contracts with student
Use environmental clues: prompts, steps, written lists, schedules
Demonstrate acceptable ways to communicate displeasure, anger, frustration & pleasure
4. Classroom Modifications
Earphones & study carrels
Reduced rote assignments
Longer time for testing
Read test to student
Assignment books & organizers
Keep notebook for parent teacher communications after each class day
5. Classroom Modifications
Computer games & programs
Peer Buddy Tutors & Helpers
Classroom shadow, 1 on 1 Assistant
Progress notes to parents
Quarterly conferences with parents
Parents selection of teacher for next school year
Medications monitoring
6. Classroom Modifications
Unconditional love of child
Willingness to extend oneself
Openness to doing things differently
Working with parents as a team
Admitting when you are lost
Flexibility
Willingness to change
7. Classroom Modifications
Getting outside help
Openness to other’s input
Enthusiasm
Optimism - “We Can” Attitude
Determination to make it work
Commitment to process and to child