question question Do you have a parent Do you have a parent organization? organization?
Dec 23, 2015
WHO IS GUILTY?WHO IS GUILTY?
This is what you may hear from your close This is what you may hear from your close environment:environment:
The child is healthy – nevertheless there The child is healthy – nevertheless there are problems, how is that?are problems, how is that?
When the child is involved in an accident –When the child is involved in an accident –(for instance has taken(read: drinking) (for instance has taken(read: drinking) toxins) you are guilty toxins) you are guilty
You do not provide structure the child You do not provide structure the child needsneeds
Research of Russ Barkley and Research of Russ Barkley and CunninghamCunningham
OBSERVATIONAL STUDIES INDICATE OBSERVATIONAL STUDIES INDICATE THAT MOTHERS ARE ACTING IN A THAT MOTHERS ARE ACTING IN A NEGATIVE WAY TOWARDS THEIR NEGATIVE WAY TOWARDS THEIR CHILD WITH ADHD: THEY ARE CHILD WITH ADHD: THEY ARE COMMANDING, VOICE MUCH COMMANDING, VOICE MUCH CRITICISMCRITICISM
WHAT IS THE DIRECTION? WHAT IS THE DIRECTION?
MOTHER - CHILDMOTHER - CHILD
TEST: THE DUO HAD TO RESOLVE TEST: THE DUO HAD TO RESOLVE PROBLEMS – THEY HAD TO WORK AS PROBLEMS – THEY HAD TO WORK AS A TEAMA TEAM
WHEN CHILD WAS ON MEDICATION WHEN CHILD WAS ON MEDICATION (METHYLPHENIDATE) THE MOTHER (METHYLPHENIDATE) THE MOTHER WAS ACTING LESS NEGATIVEWAS ACTING LESS NEGATIVE
CONCLUSIONCONCLUSION
NEGATIVE BEHAVIOR EMANATES NEGATIVE BEHAVIOR EMANATES FROM THE ADHD CHILDFROM THE ADHD CHILD
STROES ALBERTS AND VAN STROES ALBERTS AND VAN DER MEERE. JAACP (2004)DER MEERE. JAACP (2004)
CHILD WITH ADHD – STUDENTCHILD WITH ADHD – STUDENT
SPONTANEOUS BEHAVIOR OF THE SPONTANEOUS BEHAVIOR OF THE STUDENTSTUDENT
CHILD TRIGGERED STRUCTURE CHILD TRIGGERED STRUCTURE PROVIDING BEHAVIOR IN THE PROVIDING BEHAVIOR IN THE STUDENT IN LESS THAN A MINUTE STUDENT IN LESS THAN A MINUTE
WHAT MAKES THE CHILD WITH WHAT MAKES THE CHILD WITH ADHD SO VULNERABLE?ADHD SO VULNERABLE?
1) HE/SHE LOOKS HEALTHY1) HE/SHE LOOKS HEALTHY
2) PERFORMANCE FLUCTUATES2) PERFORMANCE FLUCTUATES
3) HE CAN WHEN HE WANTS3) HE CAN WHEN HE WANTS
DEFINITION OF ADHDDEFINITION OF ADHD
FLUCTUATIONS IN STATE IS CHILD’S FLUCTUATIONS IN STATE IS CHILD’S TRAITTRAIT
READING – BRAINREADING – BRAIN CLUMSINESS – BRAINCLUMSINESS – BRAIN MOTIVATION – BRAIN (GUILTY?) MOTIVATION – BRAIN (GUILTY?)
COMORBIDITYCOMORBIDITY
Motivation versus cognitive deficitMotivation versus cognitive deficit
ADHD – Oppositional Defiant DisorderADHD – Oppositional Defiant Disorder Conduct DisorderConduct Disorder
- Learning disabilities - Learning disabilities
extra effort
no extra effort
optimal state non-optimal state
Perf
orm
an
ce
Actual state vs. required (target) state – effort allocationActual state vs. required (target) state – effort allocation
Theory of state regulationTheory of state regulationVan der Meere (2005) In Gozal & Molfese Van der Meere (2005) In Gozal & Molfese ADHD: ADHD: from genes to patientsfrom genes to patients Totowa NJ Humana press) Totowa NJ Humana press)
Controls > ADHD: Fast Go Correct ADHD > Controls: Fast Go Correct
Controls > ADHD: Slow Go Correct ADHD > Controls: Slow Go Correct
NRT is a neural sheet draped over the lateral/anterior aspects of the thalamus
NRT is the functional interface between the arousal and attention systems
Receives axonal collaterals from corticothalamic, thalamocortical and reticular formation projections
Nucleus Reticularis Thalami
Portas et al. 1998, J. of Neuroscience, 18
Stress response defined in terms of Stress response defined in terms of occurrence of facial movementsoccurrence of facial movements
Lips Part Jaw drop
Lip Pressor Lip Suck
Van der Meere, BVan der Meere, Böörger, & Wiersema (submitted)rger, & Wiersema (submitted)
Gemiddelde frequentie lipspart
Periode
654321
Aa
nta
l
30
20
10
0
groepscode
Controle
ADHD
Mean frequency facial movements
jjjjjjjjjjjj
group
Time on task
conclusionconclusion
ADHD associated with poor state ADHD associated with poor state regulation (underactivation) : in common regulation (underactivation) : in common parlance “poor motivation.parlance “poor motivation.
More research needed on factors that More research needed on factors that regulate energy metabolism in ADHD regulate energy metabolism in ADHD
IN THE MEANTIME IN THE MEANTIME
RESEARCH INDICATED THAT THE RESEARCH INDICATED THAT THE SEVERITY OF THE ADHD SYMPTOMS SEVERITY OF THE ADHD SYMPTOMS IS RELATED TO STRESS IS RELATED TO STRESS EXPERIENCED BY PARENTSEXPERIENCED BY PARENTS
See: Anastopoulos et al (1992). Parenting See: Anastopoulos et al (1992). Parenting stress among families of children with stress among families of children with ADHD. Journal of Abnormal Child ADHD. Journal of Abnormal Child Psychology, 20, 503- 520. Psychology, 20, 503- 520.
Stress in familiesStress in families
Symptom Checklist 90-Revised Symptom Checklist 90-Revised (Derogatis, 1983). Manual for the SCL-90. (Derogatis, 1983). Manual for the SCL-90. Baltimore, MD.Baltimore, MD.
90 items 5 point scale 90 items 5 point scale Depression and somatic complainsDepression and somatic complains
Reduce stressReduce stress
Family therapy/ parent training – it leads to Family therapy/ parent training – it leads to an increase in parenting self-esteem and an increase in parenting self-esteem and reductions in overall stressreductions in overall stress
Behavioral management principles Behavioral management principles
Take breaks Take breaks