Dr. Lori Desautels 317-207-0336 brain@revelationsineducation.com

Attention Deficit Disorder? A New Definition- Dr. Russell Barkely

I was privileged to listen to an audio review of new research shared by Dr. Russel  Barkley who is delving into the causes, and not just the symptoms of ADD and ADHD  in this time when our children and adolescents are being diagnosed at unprecedented rates!  My graduate students were required to reflect upon this presentation and their insight, notions, and applications to their classrooms was incredibly accurate and powerful!

 

Attention Deficit Disorder shows up  with impulsive, inattentive and unfocused behaviors but there is more… The Executive Function ( our doing brain behind our foreheads is really struggling! ) Please read, respond and ponder! Thank you Dr. Barkley!!

 

 

Brent Freeman

EDU 549 Collaboration & Consultation

Dr. Lori Desautels

Notes:

Dr. Russell A. Barkley, professor of psychiatry at University of South Carolina, is a foremost expert in attention deficit disorder.  I appreciated his acknowledgement of the superficial symptoms of ADHD and the underlying development of self control.  His new theory is that there are five executive abilities that are being disrupted by ADHD, one of which is to exhibit self-restraint or inhibition, which he calls the mind’s brakes. The second is the mind’s eye, or the inability to have hindsight or foresight to visualize. The third is the mind’s voice, which is for self direction to provide instructions and clarify thinking. The fourth is the ability to control your emotions, to inhibit strong emotions and buy time to reappraise the situation, redefine it, and develop a different response. The fifth executive function is the mind’s playground, used for inventive problem solving. These all act in concert to organize life over time and those with ADHD are unable to do so. The assumption is that these individuals choose not to care, but these are neurobiological rooted issues that are often genetic in nature.  Knowledge and memory are not the problem. Working memory though, is different: holding actively in mind the goal you have, and the steps you want to take to get there. This is where ADHD makes it very difficult, because the things in front of you are more compelling than what is in your mind. There are alarmingly high co-morbidities with ADHD, it is not a simple disorder.

Sluggish cognitive tempo (SCT) is a pattern of symptoms where a person is daydreaming, sleeping, slow-moving behavior. SCT is a problem of accuracy, while ADHD is a problem of productivity. It is a free standing disorder of attention that co-exists with ADHD in about 40-45% of cases.  SCT shows no linkage to anti-social behavior or oppositional behavior, which is different than ADHD.  Should an adult work to overcome their disorder or adjust their lifestyle to avoid their disorder? Barkley suggests both, indicating that many people with ADHD do well in self-employment or highly active, exciting, ever-changing lifestyles, but that we all have to do things we don’t like during our life and have to maintain a certain level of self-control to manage those things.

There is an impact on relationships, but it’s never too late to treat this disorder. Treatment: stimulant drugs vs. non-stimulant, stimulants are largely effective.

Emotional control for adults is a recent idea. Several points can be coached: 1) Avoid situations that provoke us 2) Don’t pay attention to the person who is provoking 3) Suppress emotion, or down regulate.

Reflection:

I found this broadcast to be extremely interesting and informative. I learned a great deal about ADHD and added to my awareness of the disorder exponentially. There are several things that I think are helpful takeaways, aside from just raising my awareness.  I can see more clearly know how to structure learning environments and work on behavior modifications for students, adults and teens, who are struggling with the symptoms of ADHD. It is clear that increasing accountability, or the frequency of accountability, is an effective tool for improving the performance of students with ADHD.  I have seen this in my experience but can think of other students who would benefit from increased tracking and monitoring to raise the level of accountability they are held to. I also appreciated the coaching techniques he mentioned that are effective for adults with ADHD.  Additionally, I will be more aware of this as an untreated disorder for adults – perhaps in some cases ADHD may have been the reason that students are with us at the Excel Center. I can recommend with confidence that this is a common issue for adults and that there are very effective treatment options that exist, even if it they have never before been treated. Subconsciously, I had considered ADHD to be primarily a disorder of young people, even going as far as to think that individuals may grow out of the disorder, or stop experiencing symptoms as they age. However, it appears that this is not the case and therefore I suspect that there are a great deal of adults I serve on a daily basis who deal with ADHD whether diagnosed or not.

I appreciated the breakdown of the five executive functions and the impact that ADHD has on those functions as Dr. Barkley pointed out. It aided my understanding by breaking down the components of its impact on our neurological function.  Likewise, I found fascinating the discussion of SCT and the co morbidity with ADHD. I had understood previously that ADD still existed and was a diagnosis for those who tended to be more absent minded, spacey, day-dreamers, etc. but learned that SCT has replaced that designation.

Further, the discussion on what avenues of employment are best for adults with ADHD I appreciated Dr. Barkley’s assertion that carefully selecting career paths that provide for novelty and constant change combined with the implementation of strategies, therapy, and medication would be appropriate for adults with ADHD. At the same time, he acknowledged the responsibility we all have as adults to take part in tasks or portions of tasks that we do not enjoy, and that excusing those with ADHD from such tasks should not be anyone’s expectation. 

To summarize, the broadcast was enriching and thought-provoking. I look forward to discussing it with the class.

 

Lynn Molnar

EDU 549

Reflection – ADHD audio

February 19, 2012

Russell A. Barkley, Ph.D. on ADHD

Russell A. Barkley, Ph.D. is undoubtedly on the cutting edge of ADHD treatment.  A generic description of ADHD includes a person easily distraction and unable to sustain energy toward goal or task. Impulse and restless behavior prevents then individual from controlling mental, verbal, and physical actions.  Dr. Barkley’s theory is counter to common theory and the DSM IV label. His theory has been helping clear up the confusing caused by the existing theory. He is identifying the underlying problems of ADHD, not only the symptoms. Dr. Barkley states the five executive mental abilities disrupted by ADHD are: (1) inhibition / self-restraint, (2) hindsight and foresight, (3) self-direction / introspection, (4) emotional control, (5) problem-solving.

The executive abilities are co-dependent and help individuals organize themselves across time. People with ADHD face an increasing demand for time management skills. As they grow older, there are more deadlines and appointments. They are faced with a struggle because the executive abilities are not functioning properly and they cannot think past what is happening right now. It is not a choice for people with ADHD, but a neurological disorder. They are capable of acquiring knowledge, but not always capable of applying this as actions. Failure in using the knowledge they have will occur if not treated properly. I did not realize how much the working memory was disrupted in people with ADHD. It had never been put into perspective as a neurological disorder preventing function of the five executive abilities or disrupting working memory. As a teacher, I can now focus more intently on implementing memory or time management strategies such as visual schedules and teach students with ADHD how to advocate for their own organization in school, at home, and out in the community.

Teens and young adults are naturally at high risk for ADHD-like behavior and consequences due to the adolescent nature of impulsivity. Intimate and social relationships can be difficult because a person with ADHD may not pay attention or concentrate on the feelings or expressions of their partner or friend. Many times, the other person in the relationship is left with the responsibilities their partner with ADHD fails to do. Dr. Barkley says that if you live with somebody with ADHD, the other person may need to pay bills on time, do the dishes, pick up the kids, or make the doctor appointment. As an adult, it is also important to adjust your work schedule to adhere to the best times to work. Adults should seek out ADHD friendly environments. Self-employment tends to work well because they are on their own schedule, allow movement and change, and can meet your own expectations. Most of the literature I have read on ADHD applies to children. I had never explored the implications on adult life. This information is valuable to an educator. Since children with ADHD lack the ability to see past the present, it is my job to paint the picture of adulthood with untreated ADHD for the student and the family. I can create IEP goals formulated with ADHD accommodations and modifications in hopes of fulfilling the treatment process at a young age.

As Dr. Barkley pointed out, this is the most treatable disorder in psychology. It is diagnosed when a person experiences daily impairment in life activities. It can co-exist with other disorders such as ODD, LD, anxiety, and depression. There is not an age limit for treatment. There is research that supports predisposition for cardiovascular disease due to the ADHD lifestyle. Stimulant drugs have been used to help ADHD symptoms and there are reports of side effects such as oppositional behavior, lack of emotion, ticks, or moodiness. Pre-existing conditions usually tie to these side effects. Only about 3% of people cannot tolerate the side effects. Overall, stimulants have been largely beneficial to a larger part of the ADHD, medicated population.

I have experienced a student with ADHD on and off the medication. His guardianship has shifted and each guardian has a different view of the medication. So, he began the school year without taking medications. Then, routinely took his medications for four months. When his guardianship recently changed, the new guardian refused to administer the medication due to his own opinions. There are night and day differences with this student when he is medicated and when he is off medications. He is compliant, focused, and motivated to succeed when he is on his medication. When off, he is non-compliant, impulsive, oppositional, and vocalizes he “doesn’t care” often. He is extremely intelligent and sacrifices his grades as he feels there is no need to prove his knowledge by doing assignments in school.

This seems like a simplistic explanation, but it is frustrating as the teacher to see his development come to a halt when he becomes non-compliant with his medications due to his guardian’s influence. His emotion is clearly tied to this disorder and his medications and it is no wonder why he is in the self-contained EH classroom. My job is to coach him on his own accountability as I learned from this audio clip by Dr. Barkley. I believe if he was consistent with is medication, he could easily integrate into the general education classroom and prepare himself for the realistic world of middle school (no self-contained environment). He needs quick consequences and an increased expectation of accountability. “Society does not want yet another class of victims claiming that they can’t be held responsible for what they’ve done….I prefer to argue for designing these environments that are more conducive to accountability and that’s the way you address AHDH,” Dr. Barkley.

 

 

Nick Parks

2/14/12

EDU 549

 

ADD Reflection

 

            I found the interview featuring Russell Barkley to be incredibly informative and thoughtful.  Having been diagnosed with ADD in fifth grade, I appreciated his approach towards the disorder as having a “deeper problem” that is rooted in self-control. Superficially, he acknowledges that paying attention, sustaining activities, and impulsivity are all identifiable features of the disorder, but he emphasizes the need to address the cause of these behaviors rather than the behaviors themselves.  He notes how these superficial characteristics can often cause us to neglect the deeper problem which relates to his defining of executive abilities (inhibition, self-awareness, the mind’s voice, emotional control, and the mind’s playground).  Barkley proposes that ADD/ADHD interferes with these interrelated functions to the point that the superficial behaviors appear.  However, rather than address the superficial and external, Barkley’s research proposes that treatment focus on the internal causes.

            In addressing the question of whether comorbidity affects those with ADHD, Barkley clarifies that understanding the dimensional nature of ADHD will help to recognize the features of the disorder, but it should not be diagnosed until it causes some kind of impairment.  Additionally, he goes on to discuss how ADHD often coexists with one of more other disorders, such as oppositional defiance disorder and anxiety disorder.  He makes this point to stress how varied the symptoms and temperament of each individual can be.    In this portion of the discussion, he also dispels the myth that ADHD and autism spectrum disorder cannot overlap; although they often do not occur together, in cases where a person with autism demonstrates extreme impulsivity, they may have ADHD.

            Given the complexity in accurately diagnosing ADHD (especially when taking into account those with secondary disorders), Dr. Barkley and the interviewer also consider the outcomes for those who live with ADHD into their adult life.  Barkley actually introduces self-employment as a very “ADHD friendly” job because of the stimulating and changing notion of day-to-day work.  While self-employment is not necessary for successful integration into the workforce, Barkley does stress how those with ADHD must find ways to manage their disorder in their professional and personal lives as time goes on.  Whether an adult of child, Barkley point out that coping mechanisms are necessary when dealing with the impulsive nature of the disorder.  He is optimistic in that he suggests anyone with ADHD can lead a meaningful life as long as they are willing to be proactive in addressing their stumbling blocks.

 

 

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