ADHD & INTELLECTUAL DISABILTIY

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ADHD & INTELLECTUAL DISABILTIY HOME STUDY, 1 HOUR ATTENTION DEFICIT HYPERACTIVITY DISORDER ADD Attention Deficit Disorder ADHD Attention Deficit - Hyperactivity Disorder According to the DSM-5, ADHD

interfere with the person s quality of life in two or more settings for a minimum of six months.

They have difficulty maintaining focus on tasks and conversations, and often miss important details. They are typically disorganized losing things and forgetting daily activities.

1 ADHD & INTELLECTUAL DISABILTIY HOME STUDY, 1 HOUR ATTENTION DEFICIT HYPERACTIVITY DISORDER ADD Attention Deficit Disorder ADHD Attention Deficit - Hyperactivity Disorder According to the DSM-5, ADHD is defined as A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development For diagnosis, symptoms must be present before the age of 12 and interfere with the person s quality of life in two or more settings for a minimum of six months. A person may display a Predominantly inattentive, Predominantly hyperactive / impulsive, or Combined presentation. People experiencing Inattention may wander off task and seem to lack persistence. They have difficulty maintaining focus on tasks and conversations, and often miss important details. They are typically disorganized losing things and forgetting daily activities. People experiencing Hyperactivity and Impulsivity can appear restless, excessively moving or talking when it is not appropriate. They have a difficult time waiting their turn in activities and conversations. They often engage in potentially harmful activities due to an inability to think ahead to potential consequences. They typically perform better when rewards are immediate, as they have trouble with delayed gratification. Although not diagnostic of ADHD, it is not uncommon to see the following Associated Features: low frustration tolerance, irritability, and mood swings. ADHD is NOT resistance to tasks due to refusal to conform to the demands of others. For the person with ADHD, tasks are resisted due to the required effort (and the person s inability) to focus. People with ADHD do not typically engage in serious aggression toward others or self-injury. People with ADHD may be perceived by others as: lazy, irresponsible, or un-co-operative. ADHD IN ADULTS For many years it was believed that ADHD was a disorder of childhood and adolescence and resolved by adulthood. Recently, we have begun to recognize that ADHD can persist into adulthood. (NOTE: All adults with ADHD had ADHD as children, whether or not it was diagnosed). Because of the different types of demands in the work (vs. school) environment, symptoms may present a bit differently. According to webmd.com, adult ADHD behaviors / difficulties include: anxiety, chronic boredom, chronic lateness & forgetfulness, difficulty controlling anger, impulsiveness, low frustration tolerance, low selfesteem, poor organizational skills, relationship problems, and substance use/ abuse. Symptoms may vary in severity, and with the situation. Some may seek stimulation while others avoid it. Some may be withdrawn while others may be overly social.

2 PAGE 2 ADHD AND THE ID POPULATION ADHD in adults with ID may have a more severe presentation and an uneven and less favorable pattern of improvement across the lifespan in comparison with adults without ID. Journal of Intellectual Disability Research, 2010 There is a great deal of disparity among the literature as to the prevalence of ADHD in people with Intellectual Disability. Some of this appears to be related to the lack of diagnostic tools that are geared toward this population. Additionally, the symptoms of ADHD can be similar to the presentation of the ID itself. In children with ID, it is estimated that 25 to 40 percent have ADHD (American Academy of Pediatrics, 2012). Although one study showed that rates of ADHD dropped as children with ID transitioned into adulthood, others have put the prevalence rate for adults with ID at 17 to 52 percent. What does appear more clear is that symptoms of ADHD are more serious and enduring in people with ID, and may be less responsive to the typical medications (with an increased susceptibility to side effects). The severity of ADHD symptoms correlates with the severity of ID. Children with ID and ADHD also have shown higher rates of co-occurring Oppositional Defiant Disorder and Conduct Disorder compared to ADHD children without ID (Journal of Pediatrics, 2013). Because both ID and ADHD affect cognitive functioning (such as memory; the ability to plan, problem-solve, and make decisions; and attention itself), some refer to a double deficit, in that the presence of both ID and RISK FACTORS, CO-OCCURRENCE, AND RULE-OUTS ADHD has a strong genetic component, so presence in a blood relative increases one s risk. Additional risk factors include: exposure to nicotine, alcohol, drugs, or environmental poisons in utero; premature birth or very low birth weight; childhood exposure to environmental toxins (ex. lead); and a history of child abuse, neglect, and/or multiple foster placements. Additionally, the risk for males to have ADHD is twice that of females. ADHD presentations have been linked to several genetic syndromes, including: Klinefelter Syndrome, Williams Syndrome, Turner Syndrome, Phenylketonuria, Velocardiofacial Syndrome, neurofibromatosis, and Tuberous Sclerosis Complex. The highest prevalence is in Fragile X Syndrome, with almost 3/4 of all boys with FXS diagnosed with ADHD. In addition to genetic syndromes, ADHD commonly co-occurs with other psychiatric conditions, including mood disorders, anxiety disorders, and personality disorders. Intermittent Explosive Disorder may also co-occur, particularly in adults. The symptoms of ADHD can also be mimicked by other disorders. Clinicians may attempt to rule out some of these common conditions before diagnosing ADHD: Autism Spectrum Disorder*, Hypothyroidism, Iron Deficiency Anemia, Lead Toxicity, nutritional deficiencies, food allergies, Seizure Disorder, sleep disorders, and sensory disorders. *may also co-occur, but there is disparity as to prevalence rates HYPERFOCUS Many supporters of people with ADHD are confused by the person s capacity to hyperfocus on certain activities. When people with ADHD are engaged in something they find interesting, they are often able to focus quite well. In fact, they often focus so intensely that they do not notice anything else. They may not even respond to their own name. The phenomenon of hyperfocus has led many ADHD exp e r t s t o p o i n t t o dysregulation (vs. deficit) of attention. It is more a matter of difficulty shifting gears, especially when the person is doing something he/she enjoys. Hyperfocus commonly occurs around video games and/or the computer & internet, but can occur with any desirable activity. [People who hyperfocus] aren t being disobedient. Their brains just aren t registering what you re saying...it s almost like pulling someone out of a dream. Kathleen Nadeau, Ph.D

3 PAGE 3 DIAGNOSIS Diagnosing ADHD in an adult with ID can be challenging. Distinguishing ADHD from other medical or psychiatric conditions as well as from the ID itself can make it difficult for clinicians to determine why certain symptoms are present. As you provide the information to the diagnosing clinician, there are some helpful things to be sure to note: Symptom presentation and severity must be considered with regard to the person s developmental level (vs. chronological age) be prepared to help the clinician understand the person s strengths and limitations. Provide information from people who have observed the person in multiple settings, including information on work performance. Where are symptoms most likely to occur? (ADHD symptoms occur more often in group settings) Since ADHD must be present (even if not diagnosed) in childhood, ask people who knew the person when he/she was young or review records for past diagnoses or possible symptoms. TREATMENT The most commonly prescribed medications for ADHD are stimulants. These include methylphenidate (Ritalin, Concerta, etc.), dextroamphetamine (Dexedrine), dextroamphetamine-amphetamine (Adderall), and lisdexamfetamine (Vyvanse). Many are available in short- or long-acting forms. They are considered controlled substances due to their high potential for abuse. They tend to work quickly. Atomoxetine (Strattera) and anti-depressants (ex. Wellbutrin) have been known to work, but typically take much longer to reach full effect. People with ID in particular are sometimes prescribed the anti-psychotic risperidone (Risperdal) to treat ADHD symptoms, although this is not supported by the current research. Many believe that the symptoms of ADHD are the result of metabolic deficiencies (ex. hypothyroidism, Vitamin B 12 deficiency) or ingestion of various food additives (ex. dyes, nitrates, etc.). Some parents have reported successful treatment of their ADHD child s symptoms via elimination of certain additives (thus eliminating the need for prescription medications)....there is no research to demonstrate the effectiveness of risperidone for ADHD in people with intellectual disability Dr. Alex Thomson (2009) PROVIDING SUPPORT One of the most important things we can do to support a person with ADHD is to help them find ways to organize themselves. For example, a daily To-Do List (developed with the person) can help someone stay on track. R eminders such as sticky notes, appointment books, and alarms may also be useful. Help the person develop a daily routine for activity and possessions (ex. putting personal items in the same place). If the person appears to be hyperfocused, you may have to do something to get the person s attention (break the trance ). You might tap him on the shoulder or wave your hand in front of him. NEVER interrupt angrily. You might need to allow a few minutes for the person to switch gears. Teaching people about their diagnosis can help them understand why they do the things they do and in the process, help us as well. Supporting a person with ADHD can be frustrating it can seem as if many of the symptoms are voluntary behavior ( He s ignoring me She doesn t have any trouble completing things she wants to do ). Like all of us, people with ADHD are doing the best they can with the abilities they have. Sometimes their brains betray them.

ADHD TEST Name: Role/Title: Date: Agency: Please provide contact information (email address, fax number, or mailing address) where you would like your certificate to be sent: You must submit your

4 ADHD TEST Name: Role/Title: Date: Agency: Please provide contact information ( address, fax number, or mailing address) where you would like your certificate to be sent: You must submit your completed test, with at least a score of 80%, to receive 1 hour of training credit for this course. To submit via fax, please fax the test and evaluation to Please fax only the test and evaluation, not the entire training packet. To submit via , please send an to HCQUNW@MilestonePA.org. Please put ADHD Test in the subject line, and the numbers 1 5, along with your answers, in the body of the , OR scan the test and evaluations pages and as attachments. To submit via mail, send the test and evaluation pages to: Milestone HCQU NW, 247 Hospital Drive, Warren PA ADHD does not begin in adulthood. True False 2. A person can have either Attention Deficit OR Hyperactivity, but not both. True False 3. It can be difficult to distinguish symptoms of ADHD from those of Intellectual Disability. True False 4. People with more severe levels of Intellectual Disability typically experience more severe symptoms of ADHD. True False 5. The best way to pull someone with ADHD out of hyperfocus is to yell his or her name as loudly as you can. True False For additional information, check out the following: For a great description of personal experience with ADHD see:

5 EVALUATION OF TRAINING Training Title: ADHD Date: Direct Support Professional Provider Administrator/Supervisor Program Specialist Consumer/Self-Advocate Support Coordinator PCH Staff/Administrator FLP/LSP Provider Clinical Staff Family Member Support Coordinator Supervisor County MH/MR/IDD Other (please list): Please circle your PRIMARY reason for completing this home-study training: It s mandatory interested in subject matter need training hours convenience Please circle the best response to each question. 5 = Strongly Agree 4 = Agree 3 = Undecided 2 = Disagree 1 = Strongly Disagree 1. As a result of this training, I have increased my knowledge I learned something I can use in my own situation This training provided needed information The training material was helpful and effective Overall, I am satisfied with this training I am glad I completed this training Suggestions for improvement: Additional information I feel should have been included in this training: I would like to see these topics/conditions developed into home-study trainings:

Depression. Smoking increases one s risk of Depression by 41%. People with Intellectual Disabilities. I m sad may be expressed as I m sick.

Depression. Smoking increases one s risk of Depression by 41%. People with Intellectual Disabilities. I m sad may be expressed as I m sick. Depression March 2014 ½ hour For people with Intellectual Disabilities, I m sad may be expressed as I m sick. Smoking increases one s risk of Depression by 41%. Sanchez-Villegas, 2008 Depression Depression