Age Related ADHD? How Attnetion Deficit Hyperactivity Disorder can ruin your day.

Looking around on the web for a new video of Dr. Barkley I ran into this funny...and short ..."adult onset ADHD" video. Usually I find I can't use these humour videos because they will upset someone. But this one seems just right. Take a look:



What's interesting is how this is clearly a situation where behavioural and cognitive behavioural (CBT) training would help. One of the tools we use in my practice is an eight part course that addresses how to avoid procrastination, stay on task, deal with paperwork, planning and goal making and how to change the environment so that you can counter these weaknesses in attention and get to doing what you need to do. A simple and short "to do list" (an external prompt which, if used properly, is hard to avoid) would have made a world of difference for this person, keeping her on track and providing an external prompt as to what needs to be done. But this story, as exaggerated as it may seem, isn't too far from the problems many adults come to me with. And do you think the situation for a child or teen with ADHD is different? No, they experience life just like this. Besides medication, which can help with the issue of focus and concentration, as well as planning, there are many techniques we can use to keep ourselves on track and going steadily towards one goal at a time. Dr. Barkley's new book, Managing Your Adult ADHD, addresses many of these. But the truth is we often need some extra help and coaching to move on stay on target. The eight part course I use in my practice (more information is available from my web page) guides you through learning these specific skills.

A fun exercise might be watching this video again and seeing if you can come up with some tools, skills, prompts and supports that would have.....remember? Gotten the car washed?

For more information on ADHD (Attention Deficit Hyperactivity Disorder, parenting, child behaviour, academic problems and relationship issues, please feel free to visit my website at www.relatedminds.com I also have specific information on ADHD available at www.adhdhelp.ca and information on my counselling and assessment services can be found at either the British Columbia Psychological Association (click here), Psychology Today (click here) or my AAMFT Family Therapist website (Click here). I am a registered Psychologist here in British Columbia, along with being a Registered Marriage and Family Therapist and teacher of special education. There is also some specific information on treatment for aggression and anger in children on my webpage called "The Angry Child," (Click here)

I look forward to hearing from you.

Dr. Jim Roche
Registered Psychologist
Offices in Burnaby and Vancouver, British Columbia

Genetic mutation may be key to ADHD (Attention Deficit Hyperactivity Disorder)

While it seems popular these days to blame ADHD on food additives, parenting and "toxins" the evidence against these causes has mounted year after year. Little if any evidence for them can be found in respected scientific journals or research. Most research has pointed to ADHD (Attention Deficit Hyperactivity Disorder) being a genetic disorder, something inherited. New research further supports this, pointing to a single-letter change in the DNA code which "may spell ADHD."

ADHD -- attention deficit hyperactivity disorder (sometimes called ADD) can be found in 5% of school-aged children to learn. Kids with ADHD may be impulsive, can't sit still, they can't focus their attention and have trouble learning and remembering. (Different combinations of these symptoms leads to "inattentive type," "hyperactive type," and "combined type." Korean researchers report that children with ADHD tend to have a particular DNA misspelling -- a single-nucleotide polymorphism or SNP -- that affects an important brain function gene called GIT1. This has long been suspected, and this research backs up the theory.

Mice genetically engineered to carry this SNP "misspelling" are hyperactive and have poor learning and memory skills. But when given stimulant ADHD drugs, these mice exhibit normal behaviour. "Our study reveals a previously unidentified role of GIT1 in ADHD and establishes a new mouse model for ADHD," conclude Hyejung Won of the Korea Advanced Institute of Science and Technology and colleagues in the journal Nature Medicine.

More recently Won and his colleagues compared the genomes of 192 Korean children with ADHD to 196 age-matched children without ADHD. It was very rare for any child to inherit copies of gene mutation from both parents. Having just one copy of the mutation meant a 2.66-fold higher risk of ADHD.

Mice needed two copies of the mutant SNP to get ADHD, not just the single copy linked to ADHD in children. But these mice had nearly all the symptoms of human ADHD -- and just like children, their symptoms improved when they got stimulant ADHD drugs.

Just like some children with ADHD, mice with the ADHD genetic mutation tended to get over their ADHD when they grew up. At a mouse age of 7 months, equivalent to human age of 20 to 30 years, ADHD symptoms spontaneously went away. (Well, we think, the "hyperactivity went away, but we don't know if these mice had difficulty with concentration, planning, procrastination and so on found in adult human!) It seems that brain cells maintain a careful balance between being in a state of excitation and one of inhibition. By affecting the function of the GIT1 gene, the ADHD-linked mutation makes brain cells more excitable. This is just the function we see addressed by ADHD medications.

What did we learn? Well, that there isn't any "bad parenting" or "bad teaching" to blame for the cause of ADHD. But there is something, several things, we can do. These interventions range from medication to cognitive behaviour therapy to environmental changes to make dealing with ADHD symptoms easier. For more information on this topic I suggest checking out Dr. Russell Barkley's books, Controlling Your ADHD and Controlling Your Adult ADHD. both provide excellent sources of information to understand the cause of ADHD and interventions that are science based. Avoid interventions that promise too much, avoid those that promise a lot too easy. Stick with interventions supported by real science.
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This blog is not meant to provide therapy, interventions or diagnostic services. As always, I suggest avoiding looking for answers on-line, and especially avoiding on-line diagnostic "tests" or simple check lists of ADHD symptoms. ADHD needs to be diagnosed by a professional, and as always, that diagnosis includes ruling out other possible causes for your symptoms.

For more information, assessment and treatment please feel free to contact me at:

Dr. Jim Roche
778.998-7975
http://www.relatedminds.com
http://www.adhdhelp.ca

Brain based education: Fad or breakthrough?

Brain this, brain that. This brain, that brain, everyone has a brain based program to offer your children. I was just in chapters and there was en entire table about "changing your brain." Most of it, by the way, is baloney. (Here is Harriet Hall's comments: click here) Arrowsmith School has an entire curriculum based on "brain training" but the truth is that most of this brain based training isn't going to make much difference.

Here is what all these programs are based upon: plasticity. Brain plasticity. That means we believe that by engaging in certain actions/behaviours the brain itself changes (or to be mysterious and flaky, as Dr. Aiken says, the Brain Changes itself!!!!). We really didn't believe this 20 years ago. We thought the brain grew to a certain point, a process called "pruning" took place during which we actually lost unused brain cells and neurons making the brain more efficient, and that was it. If you damaged a part of your brain, that was it. The brain, unlike the rest of the body, didn't really change or grow or heal to any great extent.

Then in the Northeast US several psychiatrists thought this might not be true and began what was called "psychiatric rehabilitation." I was (a small) part of this early research. We took what were called "back ward" patients, patients who sometimes had been sitting on the floor in the back ward of the psychiatric hospital for 10 or more years, doing little, and we brought them into the lab and put them in front of the computer and engaged them in games very similar to those your kids play now and very similar to the tasks that schools like Arrow Smith use. Watching the Arrowsmith video they look amazingly the same! And what happened? Well we compared them on many behaviour scales to patients who did not recieve the training and they became vastly better. Some talked for the first time in years, began attending groups and were actually discharged.

Amazing! These computer brain games cured these patients of many mental illnesses..... they went from sitting all day in the corner of the psych ward to walking around the grounds, meeting other people and talking and going on home visits. Wow! Brain games. A few years later were were actually able to measure increase blood flow in the brain and growth of NEW NEUROS and CONNECTIONS!

Not so fast.

There were other differences between these successful patients and the ones who remained on the psychward in the corner or on the floor. Those patients received very little staff interaction, most were spoken to 2-5 times a day by staff. They just sat, and sat, and little changed. Little tried to make them change. The "brain game" patients were moved off the ward twice a day to the treatment center, talked to, encourage, reinforced (with points traded for candy and smokes) for participating and engaging in the tasks. There really was more going on than just these brain games.

So the question was: Did the "Brain Games" change the patients, or was it the different treatment, the positive attitudes of staff, the encouragement and reinforcement for engaging in behaviours we wanted to see more of ...and measuring? The new, positive and reinforcing environment? I vote for the encouragement, reinforcement and support rather than the games.

That is basically what the skeptics say about all these brain games. Recently there was a CBC documentary on Arrowsmith, and Linda Siegel, a UBC education professor specializing in learning disabilities was interviewed for that special. During the interview questioned the effectiveness of the Arrowsmith program. She noted a lot of things, like the $24,000 a year tuition! Siegle say it was her belief...well lets just copy what is printed on Canada.com "I think the Arrowsmith program is a fraud. I think they're taking money from people and not showing any improvement in any kind of objective way..." Well a libel lawyer from Arrowsmith got an order to remove the comments about "fraud" or face legal action. And I would agree, fraud is a very strong term, and I think the people at Arrowsmith believe in what they are doing, and are sincere and positive, supportive and...well most likely great teachers. But in the end Siegel is the only real critic of the program, and she was silenced by legal threats.

The problem is, as with the "plasticity" research from the 80's, it's true that the brain can be changed through behaviour and exercises. The repetitive exercises (the "Brain Camp") that Arrowsmith uses haven't, as far as I know, been shown to improve anyone's behaviour in and of themselves. I'd vote for the reinforcing environment, friendly teachers, the new and structured environment....but these particular exercises? Not too sure. One thing we do know is that these types of repeated exercises don;t really make generalizable changes in people's behaviours, or their brains. THINKING isn't developed out of discrete repeatable computer exercises. And this goes for Arrowsmith, Brain Balance ....all of these computerized programs.

There is one computerized program that has actually shown to make actual differences in a skill that matters, and thats increasing the ability of individuals to use what we call "working memory." Working memory might best be described as your ability to hold information in your head and use it, work on it, change it, and remember it. Pearson Publishing uses a computer based program to help develop "working memory" that they have found to be effective (click here to read research on the program). One of the differences between Cogmed, Pearson Publishing and all these books on "fixing your brain" and these Brain Balance, Brain Gym and Brain Training programs is that Cogmed doesn't rely on parent statements to prove the effectiveness of their program. They don't publish pages of parent testimonials, and they don't make any claims other than those they have been able to prove. And that means they are really clear about the severe limits of their computerized "brain training" program: It has been found to help with working memory. Nothing more. It doesn't fix reading, spelling, science, music ability, art ability ...... or make your kid a novelist. it can help, in most cases, with deficits of working memory. But with poor working memory, your going to have problems with almost everything.

As a parent you need to figure this stuff out, but your resources should not be limited to poorly constructed research and never should it rely upon the testimonials of other parents. That, I can say, should always be a red flag. As usual, I suggest you ask your doctor. Or maybe give Dr. Siegel at UBC a call ....unless there's a court order forbidding her to give her opinion.

We are still at the very early stages of using these techniques. Read an article here (click here) about the assessment of another similar software program used with kids with ADHD. Finally, here's a nice video about Brain Based Education:

If your having trouble click here.






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The ADHD blog is not offered as medical advice or as a means of diagnosing or treating ADHD or any other disorder. My recommendations: Don't go on-line and take an ADHD "test." The diagnosis of ADHD is complex and involves not just looking for symptoms of ADHD, which is all that those “tests” do, but also involves ruling out other disorders that might look just like ADHD. Often individuals who think they have ADHD have other disorders, and may have co-morbid disorders such as depression, anxiety or OCD. A simple check off sheet of “symptoms” doesn’t differentiate these. So avoid these on-line "tests" which are nothing more than a collection of symptoms. You need to see a licensed or registered professional for a real diagnosis. Medical doctors can diagnose ADHD, but the diagnosis is complex and often they will make a referral to a Registered Psychologist for a full understanding of a patient’s symptoms. You can obtain a referral for a psychologist with expertise in ADHD from the British Columbia Psychological Association (BCPA).

In my practice I offer Attention Deficit Hyperactivity Disorder (ADHD) assessment and treatment services for individuals, couples, families, children and adolescents in the Burnaby, Vancouver, Coquitlam, Port Moody, New Westminster and Maple Ridge areas of the lower mainland. This includes neuro-developmental assessments, psycho-education, cognitive rehabilitation for problems with memory and concentration and cognitive behaviour therapy. I also provide diagnostic assessments for autism and Asperger's Disorder in my Burnaby office.

My web page lists a number of resources you can make use of yourself in dealing with Attention Deficit Hyperactivity Disorder (ADHD). Please visit it at www.adhdhelp.ca or one of my other sites at either Psychology Today, AAMFT, PSYRIS or my professional site. Please feel free to call if you have questions about ADHD or other cognitive issues.


Dr. Jim Roche
Registered Psychologist, British Columbia 01610
778.998-7975
www.relatedminds.com
www.adhdhelp.ca