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Chadd Syndrome Mix And Rx1

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MedicineAndHealthNeurolog
Salud y medicina
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Pediatric Neurology. COM
Why everything in one book/lecture?
The Problems ,[object Object],[object Object],[object Object],[object Object]
The goal of laying out the problems of the Syndrome Mix: “Okay, my kid has a short attention span, but why does he/she…?”
Our task ,[object Object],[object Object],[object Object],[object Object],[object Object]
Depressing? ,[object Object],[object Object],[object Object]
Neuroanatomy of ADHD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Functional Neuroimaging ,[object Object],[object Object],[object Object]
D4 receptor in ADHD ,[object Object]
Neurophysiology of ADHD ,[object Object],[object Object],[object Object],[object Object]
norepinephrine prefrontal pathway dopamine meso-cortical pathway 12-1 Stahl S M, Essential Psychopharmacology (2000)
The brain is a bunch of chemicals with illusions of grandeur.
ADHD: The Traditional, Boring Definition ,[object Object],[object Object],[object Object],[object Object]
Six or more symptoms of inattention ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Six or more symptoms of hyperactivity-impulsivity ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
DSM: 3 Types of ADHD ,[object Object],[object Object],[object Object]
Typical, Boring and Useless Description of ADHD ,[object Object]
More Accurate Description ,[object Object]
[object Object]
[object Object]
 
Psychiatry Hotline ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
New Concept of ADHD: A Problem with Inhibition ,[object Object],[object Object],[object Object]
New Definition of ADHD ,[object Object],[object Object]
This is what Jack sees:
This is what Mom sees:
Executive Function (EF) (Russell Barkley) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Inhibition / Brakes ,[object Object],[object Object],[object Object]
CEO ,[object Object],[object Object],[object Object],[object Object]
Self-Talk ,[object Object],[object Object],[object Object],[object Object]
Working Memory ,[object Object],[object Object],[object Object],[object Object]
Foresight ,[object Object],[object Object],[object Object],[object Object],[object Object]
Foresight
Hindsight Sense of time ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Shifting Agenda ,[object Object],[object Object],[object Object]
Separating Emotion from Fact ,[object Object],[object Object],[object Object],[object Object],[object Object]
Actual Symptoms of Executive Dysfunction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
More symptoms: Audience: This is IMPORTANT ,[object Object],[object Object],[object Object],[object Object],[object Object]
Other Symptoms of Executive Dysfunction ,[object Object],[object Object],[object Object],[object Object],[object Object]
Still More Symptoms ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
And Still More Symptoms… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Difficult Behaviors in ADHD Barkley, RA JAACAP (29): 546-557 Symptom ADHD Children (%) Typical Children (%)       Argues with adults 72 21 Blames others for own mistakes 66 17 Acts touchy / easily annoyed 71 20 Swears 40 6 Lies 49 5 Stealing (not involving threats) 50 7
 
Co-Occurring Conditions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ADHD: Comorbid Conditions 1 MTA Cooperative Group. Arch Gen Psychiatry 1999; 56:1076–1086. 2 Barkley R. Attention-deficit Hyperactivity Disorder. A Handbook for Diagnosis and Treatment , 2nd ed. New York: Guilford Press, 1993. 3 Biederman J, et al. Am J Psychiatry 1991; 148:565–577. 4 Milberger S, et al. J Am Acad Child Adolesc Psychiatry 1997;36:37–44. 5 Biederman J, et al. J Am Acad Child Adolesc Psychiatry 1997;36:21–29. 60 55 50 45 40 35 30 25 20 15 10 5 0 (%) Oppositional defiant disorder 1 Anxiety disorders 3 Learning difficulties 2 Mood disorders 2 Conduct disorder 3 Smoking 4 Substance use disorder 5 Language disorder 2 40% 30–35% 20–25% 15–25% 15–20% 20% 19% 15%
Learning Disabilities ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Disruptive Behavior Disorders: ODD, CD, Antisocial Personality ,[object Object],[object Object],[object Object],[object Object]
Oppositional Defiant Disorder (ODD) ,[object Object],[object Object],[object Object]
Conduct Disorder (CD) ,[object Object],[object Object],[object Object],[object Object]
Antisocial Personality Disorder ,[object Object],[object Object]
Anxiety/OCD Disorder ,[object Object],[object Object],[object Object],[object Object]
Anxiety Disorders: vs. normal worry ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Obsessive Compulsive Disorder (OCD) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Depression ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Bipolar Depression ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Bipolar cont’d. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Bipolar (versus just ADHD): ,[object Object],[object Object],[object Object],[object Object]
Bipolar vs ADHD cont’d. ,[object Object],[object Object],[object Object],[object Object],[object Object]
Tics and Tourette’s ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sensory Integration Disorder (SI) ,[object Object],[object Object],[object Object],[object Object]
SI cont’d ,[object Object],[object Object],[object Object],[object Object]
SI cont’d ,[object Object],[object Object]
Asperger’s Syndrome ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Family Problems ,[object Object],[object Object]
Family stress may lead to resentment
ADHD: Impact of Untreated & Under-Treated ADHD Patient Family 3-5x  Parental Divorce or Separation 11,12 2-4 x  Sibling Fights 13 Society Substance Use Disorders: 2 X Risk 8 Earlier Onset 9 Less Likely to Quit in Adulthood 10 School & Occupation 46% Expelled 6 35% Drop Out 6 Lower Occupational Status 7 Health Care System 50%  in bike accidents 1 33%  in ER visits 2 2-4 x more motor vehicle crashes 3-5 Employer  Parental Absenteeism 14 and Productivity 14 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Solutions PediatricNeurology.com
Summary of Drug Actions
Sources ,[object Object],[object Object],[object Object],[object Object],[object Object]
Sources, cont’d. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Keep It Positive ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Keep It Positive ,[object Object],[object Object],[object Object],[object Object],[object Object]
Positive: Bank Account ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The “No Fault” Approach (Zeigler-Dendy) ,[object Object],[object Object],[object Object],[object Object],[object Object]
Benefits of No Fault ,[object Object],[object Object],[object Object],[object Object]
Nice Traffic Cop ,[object Object],[object Object],[object Object]
Phelan’s 4 Cardinal Sins ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Maintain a Disability Outlook (Barkley) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Seek to Understand ,[object Object],[object Object],[object Object],[object Object]
Let the Teen Be a Partner ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Plan A: Token/Reward Systems (Barkley)
Criteria for Behavior Mod. ,[object Object],[object Object],[object Object],[object Object],[object Object]
Reward/Token Systems ,[object Object],[object Object],[object Object],[object Object],[object Object]
Reward Systems ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
Plan B Dr. Ross Greene The Explosive Child
Plan B: Behavior modification via staying calm to prevent “meltdowns.” “Just STOP!”
What’s Going On? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Just STOP! ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The Overwhelmed Speedometer ,[object Object],[object Object],[object Object],[object Object],[object Object]
After stopping, next: ,[object Object],[object Object],[object Object],[object Object],[object Object]
After stopping: ,[object Object],[object Object]
One more time: ,[object Object],[object Object],[object Object]
Pop Quiz ,[object Object]
Question 1 ,[object Object],[object Object],[object Object]
Question 2 ,[object Object],[object Object],[object Object]
Question 3 ,[object Object],[object Object],[object Object]
Question 4 ,[object Object],[object Object],[object Object]
Question 5 ,[object Object],[object Object],[object Object]
Classic ADHD: Just a part of the Syndrome Mix ,[object Object],[object Object],[object Object],[object Object],[object Object]
And let’s not forget the positive. ADHD people… ,[object Object],[object Object],[object Object],[object Object],[object Object]
Conclusion ,[object Object],[object Object],[object Object]
[email_address] PediatricNeurology.com

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Chadd Syndrome Mix And Rx1

  • 2. Why everything in one book/lecture?
  • 3.
  • 4. The goal of laying out the problems of the Syndrome Mix: “Okay, my kid has a short attention span, but why does he/she…?”
  • 5.
  • 6.
  • 7.
  • 8.
  • 9.
  • 10.
  • 11. norepinephrine prefrontal pathway dopamine meso-cortical pathway 12-1 Stahl S M, Essential Psychopharmacology (2000)
  • 12. The brain is a bunch of chemicals with illusions of grandeur.
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  • 21.  
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  • 23.
  • 24.
  • 25. This is what Jack sees:
  • 26. This is what Mom sees:
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  • 41.
  • 42. Difficult Behaviors in ADHD Barkley, RA JAACAP (29): 546-557 Symptom ADHD Children (%) Typical Children (%)       Argues with adults 72 21 Blames others for own mistakes 66 17 Acts touchy / easily annoyed 71 20 Swears 40 6 Lies 49 5 Stealing (not involving threats) 50 7
  • 43.  
  • 44.
  • 45. ADHD: Comorbid Conditions 1 MTA Cooperative Group. Arch Gen Psychiatry 1999; 56:1076–1086. 2 Barkley R. Attention-deficit Hyperactivity Disorder. A Handbook for Diagnosis and Treatment , 2nd ed. New York: Guilford Press, 1993. 3 Biederman J, et al. Am J Psychiatry 1991; 148:565–577. 4 Milberger S, et al. J Am Acad Child Adolesc Psychiatry 1997;36:37–44. 5 Biederman J, et al. J Am Acad Child Adolesc Psychiatry 1997;36:21–29. 60 55 50 45 40 35 30 25 20 15 10 5 0 (%) Oppositional defiant disorder 1 Anxiety disorders 3 Learning difficulties 2 Mood disorders 2 Conduct disorder 3 Smoking 4 Substance use disorder 5 Language disorder 2 40% 30–35% 20–25% 15–25% 15–20% 20% 19% 15%
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  • 66. Family stress may lead to resentment
  • 67.
  • 69. Summary of Drug Actions
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  • 80.
  • 81.
  • 82. Plan A: Token/Reward Systems (Barkley)
  • 83.
  • 84.
  • 85.
  • 86.
  • 87. Plan B Dr. Ross Greene The Explosive Child
  • 88. Plan B: Behavior modification via staying calm to prevent “meltdowns.” “Just STOP!”
  • 89.
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