Chelsea Murphy MS, NCC. Kennedy Health Systems

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1 Chelsea Murphy MS, NCC Kennedy Health Systems

2 What is ADHD? o Neurobiological Disorder deficit in the neurotransmitters (message senders within the brain) o Dopamine & Norepinephrine are not released as efficiently o Deficits occur in areas of brain responsible for: o Concentration o Decision making o Self-control

4 o Types of ADHD o Predominantly Hyperactive/Impulsive o Inattentive Type o Combined Type o ADHD vs. ADD o ADD does not exist.

5 Signs and Symptoms Hyperactivity 1. Fidgety 2. Nonstop talking 3. Touching everything 4. Switching from one thing to another 5. Difficulty sitting or doing quiet activities Impulsivity 1. Inpatient 2. Inappropriate verbal expressions 3. Difficulty waiting 4. Interrupts conversations Inattention 1. Easily Distracted 2. May switch activities frequently 3. Difficulty focusing on ONE thing 4. Quickly bored with tasks 5. Difficulty completing or turning in homework 6. Confusion 7. Daydreaming 8. Seems like not listening when spoken to 9. Difficulty processing information 10. Struggles to follow directions

6 o Development and Diagnosis o Genetic component o Parent 50% at risk o Sibling 32% at risk o Research has not discovered one specific gene o Other factors o Smoking during pregnancy o Low birth weight o Lead exposure o Food additives o These are not proven contributors, this is what researchers believe contribute to the diagnosis.

o The difficulty with symptoms should be compared to normal development of the

7 o Development and Diagnosis o Diagnosis of ADHD made by psychiatrist, psychologist or neurologist o Child must exhibit at least six symptoms over the last six months o The difficulty with symptoms should be compared to normal development of the child s age o Symptoms usually begin around age 7 o Diagnosed in boys more than girls

8 o Treatment Approaches o Treatment aims to 1. Reduce symptoms 2. Improve functioning 1. Medication Interventions 2. Behavioral Interventions

Medication Interventions o Stimulants are the most commonly used medication o Adderall, Ritalin, Vyvanse o Reduce hyperactivity and improve the child s ability to focus o

9 Medication Interventions o Stimulants are the most commonly used medication o Adderall, Ritalin, Vyvanse o Reduce hyperactivity and improve the child s ability to focus o Approximately 70-80% of children that use stimulant medication to manage ADHD symptoms saw positive results o Increase in attention o Increase in concentration o Compliance with rules improved

10 Medication Interventions o Stimulant Side effects o Decreased appetite o Sleep problems o At times Tics o According to the National Institute of Mental Health, there is little evidence that links stimulant medication for ADHD as a predictor for substance dependence in the future o Other nonstimulant medications can be successful for managing ADHD such as Kapvay and Straterra

11 Behavioral Interventions o Rewards and Praise o Use of positive reinforcement o Rewards can be established in advanced o Self-monitoring Skills o Comparing actual behavior to what the desired behavior of the child was o Schedules and Routines o Allows child to know expectations and be able to get back on track

13 School Assistance Individuals with Disability Education Act (IDEA) allows children to have a free public school education School can provide child with additional assistance through a 504 plan or Individual Education Plan (IEP) Parent can request a referral to the IR & S to seek assistance with school support.

14 How Parents Can Help o Schedules and Routine o Have the schedule for the day or week posted in a place where the child can see and reference it. o Sets an expectation for the child and a reference tool for when the child gets off track o Schedule should include bed and meal times, schoolwork, play/activities, and family time o Any changes should be posted in advanced to assist the child with what is expected to come next o Important to stick to these schedules as best you can. Consistency Counts!

15 How Parents Can Help o Teach and Practice Organizational Skills o Using an agenda book or different colored folders o Consistency Counts o Spelling out expectations, rules and consequences o Sticking to expectations rules and consequences o Praise Good Behavior o Children with ADHD are used to being reprimanded and criticized. Make sure that the child is being praised for good behavior as well.

16 How Parents Can Help o Parental Self-blame- it is normal, and it is manageable o Parent Therapy o Provides education on ADHD and how it affects the family as a whole o Parent skills training o Learning rewards, consequences, and feedback to encourage or discourage the behavior o Support groups for Parents

17 o Prognosis for Adulthood o 2/3 of children diagnosed with ADHD in childhood continue to experience symptoms in adulthood o Important to intervene to teach coping skills for success in adulthood o Remember.This does not go away.

18 Generalized Anxiety Disorder (GAD) o Excessive and persistent worrying about everyday things. o Symptoms can be mild and manageable or more severe that affect functioning Symptoms include Restlessness or feeling keyed up Easily fatigued Difficulty concentrating or mind going blank Irritability Muscle tension Sleep disturbances ( restlessness, difficulty falling asleep or staying asleep, unsatisfied sleep)

19 Separation Anxiety o Excessive anxiety when away from the home, parent, or caregiver. Child fears that something bad will happen if they are separated from one of these. o Most commonly occurs between the ages of 7-9. o Symptoms include o School refusal o Wanting someone to stay with them at bedtime Posttraumatic Stress Disorder (PTSD) o Occurs following the witness of a traumatic event or experiencing a traumatic event. Intense anxiety or fear, avoidance, irritability, nightmares, and or flashbacks

20 Social Anxiety o Fear of social situations due to concerns of being judged, criticized, or not performing up to par. o Can be seen as early as 3 or 4 years old but usually around 13 years old.

21 Social Anxiety o Symptoms o Younger Children (3-6 years old) o Clinging behaviors o Tantrums o Selective mutism o Middle Childhood (7-11 years old) o Child begins to drop out of activities o School refusal o Late Childhood/Adolescence (12-18 years old) o Avoidance of activities o School refusal

22 Social Anxiety o Shy versus Social Anxiety o Shy child- will interact with other children their age or be slow to warm up to children or adults o Child with social anxiety- will be become upset if they have to interact with others. The child will make efforts to avoid interacting.

23 Social Anxiety o School Refusal o How long as the child been avoiding school? o How much distress is the child having when attending school? o How strongly is the child resisting school? o How much is the resistance interfering with the child s life and family s life? o Is the child often tardy, wanting to leave early, or frequent trips to the nurse s office? o Is your child having physical health issues that disappear over the weekend?

24 Social Anxiety o School Refusal o Although the child may be anxious about going to school allowing them to stay home is detrimental o Children with school refusal due to anxiety tend to struggle to keep up academically, thus creating more anxiety o Allowing a child to miss school or attend school with the child sends the message that the child cannot handle this fear

25 Social Anxiety o What can we do? o It takes a village. Important to involve parents, school, and professionals o School o Anxiety is covered under IDEA o School can make accommodations for the child o Different seating arrangements o Cool down pass o Cues

26 Social Anxiety o Professionals o When a child is refusing school timing is key! o Therapeutic Interventions o Cognitive Behavioral Therapy (CBT) o Exposure Therapy o CBT- The way we think and feel affect our behavior. If we change negative ideas and maladaptive behaviors we can change the way we feel. o The goal is to unlearn the avoidant behavior. o Learn to separate self from the anxiety ex. The Bully

27 Social Anxiety o Exposure Therapy o Gradually facing and mastering a feared situation. o Using difficulty scales o Therapy Services o Outpatient 1:1 approximately once a week o Intensive Outpatient (IOP) 3-5 days a week for 3 hours o Partial Hospitalization (PHP) 5 days a week approx. 6 hours

28 Social Anxiety o What can we do? o Parents/ At Home o Enabling versus Helping o Although intentions may be good, allowing the child to stay home reinforces their fear that they cannot handle their anxiety o Parent answering questions for the child o It can become a family issues

29 Social Anxiety o What can we do? o Tips for Parents o Pay attention to your child s feelings o Stay calm when your child becomes anxious about a situation o Recognize and praise small accomplishments o Don t punish mistakes or lack of progress o Be flexible and try to maintain a normal routine o Modify expectations during stressful periods o Plan for transitions

30 Social Anxiety o What can we do? o Tips for Parents o Help the child to manage rather than avoid o Use statement that ignite confidence in the child ex. You have the tools to be successful o Validate without encouraging the belief o I know you re scared and that s okay. I m here and I m going to help you get through this. o Anticipation can be worse than the fear itself. o Talking through what the child would do if the fear came true? Would they be capable of handling it?

31 Social Anxiety o Prognosis for Adulthood o No cure for anxiety, treatment is to learn to manage o 2004 study showed that school refusal children years after the study follow up still lived with their parents and had more psychiatric treatment than children without school refusal issues. (Journal of Consulting and Clinical Psychiatry) o Untreated anxiety can lead to substance abuse problems in adolescence and adulthood by self-medicating (The Wall Street Journal)

32 Child Mind Institute What To Do and Not To Do When Children are Anxious. Dr. Clark Goldstein Worrywisekids.org Therapy: insurance website or phone number can provide resources Support- Parents Anonymous, Youth Partnership, Family Success Center

33 The Disorder named ADHD : Disorder-Named-ADHD-WWK1.aspx OCD-anxiety

Attention Deficit-Hyperactivity Disorders (ADHD) definition

Attention Deficit-Hyperactivity Disorders (ADHD) definition: a pervasive pattern of inattention, impulsivity, and/or hyperactivity-impulsivity that is more frequent and severe than is typically observed