Slide 2: So have you got students like this in your classroom? ADHD – Brain desynchronization, malfunction or something else?Some holistic approaches for identifying and managing the ADD/ADHD children! : ADHD – Brain desynchronization, malfunction or something else?Some holistic approaches for identifying and managing the ADD/ADHD children! By
Nikola Djarov DSM-IV (Text Revision) DefinitionAttention-Deficit/Hyperactivity Disorder : DSM-IV (Text Revision) DefinitionAttention-Deficit/Hyperactivity Disorder Definition: Attention-Deficit/Hyperactivity Disorder (AD/HD) is a neurobiological disorder. Typically children with AD/HD have developmentally inappropriate behavior, including poor attention skills, impulsivity, and hyperactivity. These characteristics arise in early childhood, typically before age 7, are chronic, and last at least 6 months. Children with AD/HD may also experience problems in the areas of social skills and self esteem.
According to DSM-IV (pp. 83-84), there are three subtypes:Attention-Deficit/Hyperactivity Disorder Predominantly Inattentive Type: This subtype is used if six (or more) symptoms of inattention (but fewer than six symptoms of hyperactivity-impulsivity) have persisted for at least six months.
Attention-Deficit/Hyperactivity Disorder Predominantly Hyperactive-Impulsive Type: This subtype should be used if six (or more) symptoms of hyperactivity-impulsivity (but fewer than six of inattention) have persisted for at least six months.
Attention-Deficit/Hyperactivity Disorder Combined Type: This subtype should be used if six (or more) symptoms of inattention and six (or more) symptoms of hyperactivity-impulsivity have persisted for at least six months. Symptoms : Inattention (a) often fails to give close attention to details or makes careless mistakes in schoolwork, work or other activities(b) often has difficulty sustaining attention in tasks or play activity(c) often does not seem to listen when spoken to directly(d) often does not follow through on instructions and fails to finish schoolwork, chores or duties in the workplace (not due to oppositional behavior or failure to understand instructions)(e) often has difficulty organizing tasks and activities(f) often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)(g) often looses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books or tools)(h) is often easily distracted by extraneous stimuli(i) is often forgetful in daily activities
Hyperactivity(a) often fidgets with hands or feet or squirms in seat(b) often leaves seat in classroom or in other situations in which remaining seated is expected(c) often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)(d) often has difficulty playing or engaging in leisure activities quietly(e) is often “on the go” or often acts as if “driven by a motor”(f) often talks excessively
Impulsivity(g) often blurts out answers before questions have been completed(h) often has difficulty awaiting turn(i) often interrupts or intrudes on others (e.g., butts into conversations or games)  Symptoms Short Neuroanatomy-physiological review : Short Neuroanatomy-physiological review What is Happening in the Brain of a Person with ADHD ? : What is Happening in the Brain of a Person with ADHD ? The latest researches have shown that several areas of the brain are affected:
Frontal lobes-The frontal lobes help us to pay attention to tasks, focus concentration, make good decisions, plan ahead, learn and remember what we have learned. The frontal lobes also help us to behave appropriately for a given situation. Emotional issues such as anger, frustration, and irritability that come on impulsively in some types of ADHD probably come from the pre-frontal cortex.
Inhibitory Mechanism of cortex-The Attention Deficit Disorder children have show n excessive slow brainwave activity (theta and alpha ranges) compared to non- ADD ADHD activity. The slow brainwave activity indicates a lack of control in the cortex of the brain.
Limbic system-The limbic system is the base of our emotions and our highly vigilant look-out tower. If the limbic system is over-activated, a person might have wide mood swings, or quick temper outbursts. He might also be "over-aroused," quick to startle, touching everything around him, hyper –vigilant.
Reticular activation system-The Reticular Activating System is the attention center in the brain. It is the key to "turning on your brain," and also seems to be the center of motivation.The Reticular Activating System is connected at its base to the spinal cord where it receives information projected directly from the ascending sensory tracts. The brain stem reticular formation runs all the way up to the mid-brain. , Marked areas:A. Spatial working memoryB. Spatial working memory, performance of self-ordered tasksC. Spatial, object and verbal working memory, self-ordered tasks, analytic reasoningD. Object working memory, analytic reasoning : Marked areas:A. Spatial working memoryB. Spatial working memory, performance of self-ordered tasksC. Spatial, object and verbal working memory, self-ordered tasks, analytic reasoningD. Object working memory, analytic reasoning MRI scans of normal and ADHD brainsactivity : MRI scans of normal and ADHD brainsactivity In these PET scans (a type of radiology imaging), the brain of the ADHD patient (right) shows less activity, especially in the frontal areas (top of the image) compared with the non-ADHD patient (left). General approaches for managing ADHD : General approaches for managing ADHD Psychotherapy
Medication General approaches for managing ADHD : General approaches for managing ADHD Medications:
Stimulants –Methylphenidate/(Ritalin) it’s a Schedule II drug which acts on dopamine and norepinephrine, to block reuptake from the space in between cells. Variants: Concerta, Focalin, Metadate, Daytrana
Adderal is a is a mix of several amphetamine salts and like Ritalin is a highly effective treatment.
Vyvanse/Dexedrine-it’s made only from the d-type of amphetamine with none of the l-type.
Non stimulants - Intuniv is a treatment that was initially used for lowering blood pressure and has recently become more fashionable for treating ADHD, a use for which it was recently approved. Intuniv is pretty much the opposite of the stimulants, which raise blood pressure and stimulate the body. Variants: Clonidine, Guanfacine. Stratera - Like Ritalin, Strattera also works on the norepinephrine chemical and prevents its removal from the space in between cells. Despite a similar mechanism of action, it does not have work immediately, however. It can take up to 8 weeks for Strattera to show its full benefit. Provigil/ Modafanil - It keeps enough of the amphetamine like behavior of Adderall to provide the kick needed to treat ADHD, while having a host of other chemical behaviors that, some argue, may make it less addictive and less risky.
Wellbutrin is a antidepressant which act as an inhibitor of reuptake of norepinephrine and dopamine, and could convert by the body into some form of amphetamine. The Tricylcic class of antidepressants has been shown to have significant benefit in treating ADHD. They reduces some of the ADHD symptoms, especially behavioral, may start occurring in less than a week, as opposed to the 3-4 weeks it takes for the antidepressant effect.  Have you ever heart about all this people ? : Have you ever heart about all this people ? Architect- Frank Lloyd Wright
Artists-- Salvador Dali, Pablo Picasso, Vincent Van Gogh
Athletes-Terry Bradshaw, Michael Phelps, Pete Rose, Nolan Ryan, Michael Jordan, Jason Kidd
Authors-Charlotte and Emily Bronte, Samuel Clemens, Emily Dickenson, Edgar Allan Poe, Ralph Waldo, Emerson, Robert Frost, George Bernard Shaw, Henry, David Thoreau, Leo Tolstoy,
Tennessee Williams,, Virginia Woolf, William Butler Yeats
Composer-Wolfgang Amadeus Mozart
Entrepreneurs and Business Leaders-Andrew Carnegie, Malcolm Forbes, Henry FordBill Gates, David Neeleman, Paul Orfalea, Ted Turner
Explorers- Christopher Columbus, Lewis and Clark
Entertainers-Ann Bancroft, Jim Carrey, Steve McQueen, Jack Nicholson, Ty PenningtonElvis Presley, Evil and Robbie Knievel, Sylvester Stallone, Robin Williams, Wright Brothers
Inventors -Alexander Graham Bell, Thomas Edison, Benjamin Franklin
Photographer - Ansel Adams
Physicist - Albert Einstein
Political Figures - James Carville, John F. Kennedy Slide 14: What are the two common facts that united all of them? Slide 15: How they succeeded in their lives without a modern technology, medication and guidance? Holistic approaches for managing ADHD : Holistic approaches for managing ADHD To Empower! - Not Control! Looking at the whole child is the key concept used in this approach. Very seldom you will find a positive report or article, which stresses on the ADHD strengths, rather than there deficits.
There are several aspect of this approach which we have to change to succeed with the integration of this students:
Cognitive is using focusing and attention training skills.
Ecological is focusing on the proper food intake, the personal timing tasks and environment preferences.
Physical is based on giving the students opportunity to move in the class in appropriate matter, the use of manipulative and hand-on teaming.
Emotional is based on the multi intelligence approach and the necessity of the role-models.
Behavioral is using the behavior contract like a tool and requires immediate feedback.
Social is using class meetings and communication strategies which stresses on the “I” language.
Educational is using the high stimulation, not low stimulation conditions and attention- grabbing strategies.
Can you add some more aspects which could be useful? Optimizing neurological development : Optimizing neurological development Optimizing neurological development – this treatment is base on the concept of the Neuro- Development Treatment (NDT) approach, which primary was design for treatment CP children by K.Bobath and B. Bobath. The type of motor response to a sensory input that occurs within the brain stem is always a reflex reaction. The concept is that by inhibiting some of the Primitive and Postural reflexes( which still remain intact) we can give the chance to the brain to re-educate itself.
The retention of some of those reflexes is directly related to the education process:
Moro Reflex - Mood swings , Unexpected sudden changes of behavior, Aggressive outbursts, Perceptual difficulties both visual and auditory, Copying difficulties, Over sensitivity to particular frequencies of sounds and textures.
The Grasping Reflexes (Palmar, Plantar, Rooting and Infantile Suck Reflexes)- Poor pincer grip between thumb and forefinger, Immature pencil grip, Poor control of mouth for speech, Poor co-ordination of breathing and speech, Poor running skills.
ATNR - Poor reading skills, inability to follow a line, getting lost along the line, losing place, Blurring and double image as the two eyes cannot work together for binocular vision, Inability to read when there are many lines on a page rather than the odd word and pictures, Poor writing and copying, Poor hand eye co-ordination, Hates writing, slow with much less achieved than would be expected, Difficulty with spelling and grammar and context both in reading and writing, Poor co-ordination, balance difficulties when moving, Reversal of letters, numbers, Confusion with tens and units, Continues to draw a circle in a clockwise direction, Difficulty following multiple instructions, poor memory, Imaginative, artistic, but with poor sequential skills, poor at arithmetic, tables, Selfishness, Can’t wait for reward, wants everything NOW.
TLR - Poor posture with either stooping or arching of the body backwards, Poor balance, falling, Poor spatial awareness, difficulty knowing where self is relation to space and others: sitting too close, poor development of personal space, hitting head in swimming pool, Poor arrangement of work on paper, Poor near vision, reading and copying difficulty, Problems with spatial concepts in math, algebra, geometry, Problems with grammar and tense, Poor short term memory, Inability to swing from or climb a rope. Optimizing neurological development : Optimizing neurological development STNR - Poor sitting position, head lowering to desk as working, Poor standing position, stooped shoulders, bent knees, flexed hips, Preference to sit on the floor, or lie on floor or couch, Fidgeting whilst sitting, concentration difficulties, Reading difficulty from seated position, Poor attention to work, poor quality and amount, Poor writing and copying, many errors in copying, very slow, Poor impulse control, Poor concentration and short term memory.
Spinal Galant Reflex-Poor control of legs, Poor speech development, Poor listening skills, Poor development of grammar and spelling.
Treatment by using kinesthetic exercises- The basis of the exercises is to give the brain a second chance by repeating similar movements that should naturally occur in the first year of life. About 90% of all sensory nerves are situated in the muscles, and ligaments, informing us of the relative position of our limbs and body in relation to ourselves and space. Movement will therefore always stimulate a good proportion of that 90% of sensory nerves. The fact that there is such a large percentage of sensory nerves related to muscle position demonstrates how important movement is in the whole scheme of awareness and adjustment. Awareness and adjustment being the two vital components of learning. The effects of treatment are usually visible very quickly, but they rarely address the reading and writing difficulties initially. Some additional exercises encourage development of this enlarged nerve network between the various specialist centers within the brain, increasing the number and speed of communication between the specific senses. ,
Can you accept the challenge to complete NDT course? Enhance Learning Performance : Enhance Learning Performance Build a solid neurological foundation that supports vibrant living and learning practices, starting with fetal development and continuing throughout life. Fully develop the sensory-motor systems called upon to read, write, spell and think logically. Strengthen the visual, auditory, tactile and proprioception systems through Neuro-stimulation.
Here are some practical strategies ready to use related to the mention above concept:
WARM UP – Take a few deep, relaxing breaths with your eyes open or closed, feel a sense of peaceful relaxation. RUB your HANDS together, feel the heat, then place your hands over your face and feel the soothing warmth. Very gently massage the forehead, temple, ears, nose, lips and cheeks, stimulating the trigeminal nerve connecting these senses.
ACTIVATE BOTH HEMISPHERES – STAND and perform CROSS-LATERAL movements – HIGH, LOW, FAST, SLOW, BIG, SMALL, NOT AT ALL
NEW PHYSICAL ACTIVITIES-Researchers at John Hopkins found that after 5 or 6 hours of learning a new physical skill, the brain shifts from short-term memory in the pre-frontal cortex to long-term memory in the posterior parietal cortex and cerebellum. Even without practice – these new skills become hard-wired into the brain.
TRY THESE VISUAL ACTIVITIES-Mirror the movements of the leader or partner – try to mimic them perfectly , Focus on your index finger as it traces the wheel design posted on the wall, Catch a ball or bean bag. Toss them to yourself throwing and catching with opposite hands, Recite the words as they are quickly flashed on cards in front of you.
TRACE - Here is a highly effective way to teach reading and spelling – even the most dyslexic can experience success. The method involves tracing. The hand movements engage the motor cortex – however make sure the tracing movements are large, involving the arm to build the neural connections. Tracing engages the parietal lobe – the part of the brain where writing and spelling resides. This is especially helpful to those students who don’t have association fibers connecting the temporal lobe (involved with saying words orally) and the parietal lobe (which handles spelling and visualization). These students can spell orally but find it difficult to write the words correctly. Tracing will embed the images throughout the brain, helping them succeed. Enhance Learning Performance - continues : Enhance Learning Performance - continues Vestibular Challenges - The vestibular system provides the basic framework for visual, auditory and body senses to make sense of time and space. When immature, the vestibular system interferes with learning – students may need to move continually to orient themselves. Forced to sit still, they may be lost in space. Disoriented – they may overreact to situations. Constant movement (e.g., wiggling, shaking the head, bouncing in chair) is needed to stay focused. Spinning, stopping and starting, swinging, balancing activities are required in that cases.
Improve Reading -Three brain systems involved with reading – the inferior frontal gyrus (Broca area) handling articulation, the back left side parieto-temporal region analyzing and sounding out the parts of words, and the occipito-temporal (visual word-form area) where all information relating to words and sound comes together so that the reader recognizes and reads the word instantly using. SMART type of phonemic awareness and letter-sound relationship activities.
Instant Word Recognition - Catch a bouncing ball for each word read moving up the vertical chart.
Instant Math -Skip Count: Bouncing a ball, or catching a bean bag, exchanging hands for each number identified, recite the numbers on the vertical number chart from the bottom, moving up. This activity develops hand-eye coordination used for reading, also implicit memory tracks with many practices sessions.
Proprioception -Breathe deeply (diaphragmatically) swelling the belly on the inhalation, sighing on the exhalation. Move around the room jumping, hopping, skipping, galloping as directed. Bibliography : Bibliography 1. ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD), extract from” Disability definitions and accommodations” /Kentucky's Office for Americans with disabilities act http://ada.ky.gov/adhd_def.htm
2. ADHD Brain: The Neurology of Inattention, Impulsivity, and Hyperactivity/extracted from new ideas-http://newideas.net/adhd/neurology
3. ADHD Neurobiology/extract from Jenna Saul/CAPC/Images are from Scientific Americans/http://www.drjenna.net/disorders-and-treatments/adhdattention-deficit-hyperactivity-disorder/neurobiology-2/
4. A Full List of ADHD Medications/extract from Health and Life/http://healthlifeandstuff.com/2009/12/the-ten-most-important-adhd-meds/
5. Thomas Armstrong -“Attention Deficit Hyperactivity Disorder in Children': "ADD/ADHD Strategies”,” One Consequence of the Rise of Technologies and the Demise of Play” http://www.thomasarmstrong.com/articles/ADHD_Demise_of_Play.php
6.Sue Hyland – Optimizing Neuro development - http://suehyland.co.uk/ond/
7.Dr. Yannick Pauli – ADHD and the Brain, © 2009. The UnRitalin Solution
8.Jeff Haebig, Ph.D-.Build the Body/brain’s Capacity for Dynamic Living
9.You Tube – Child off meds- http://www.youtube.com/watch?v=gmQ0jfGTWbw
10.You Tube – ADHD and the Brain - http://www.youtube.com/watch?v=u82nzTzL7To Slide 22: THANK YOU!