Morabeto Mind Legacy Associates Inc.
With Instructor:

Janice R. Morabeto M.Ed. L.S.W. C.H.T.

On Demand Training Modules
•	Enjoy the fact that you will not have to be traveling today to get your C.E.U. hours met!
•	Get prepared to learn!  If you normally take notes during lecture, do that as you take this On demand class.  It will help you to remember what you learned better, longer and be able to apply that knowledge when you need it most!
•	Take advantage of downloading and printing the PowerPoint presentations before class begins.  
•	Email me at info@mindlegacy.com if you have questions regarding the content of this material, or if you are interested in future C.E.U. Opportunities.
ADHD:  A bio-Psycho-Social Approach to Understanding

Course Description
•	ADHD is the most common psychiatric disorder diagnosed in children in America.  It remains, as well, one of the most controversial in terms of diagnosis and treatment approaches.  Recently, the fields of neuroanatomy, molecular genetics and neurochemistry are beginning to shed some real light as to the complexities, and actualities of this important disorder.
Agenda:  to Explore the current research 
How about a little review!
•	Take this 5 question pre-test to review and learn!

•	Spend only 2-3 minutes on it

•	Answers will be reviewed before I continue with the presentation.
How can this information help you to be more effective in working with these children?
•	Many people feel manipulated by the ADHD individual due to the inconsistencies of their behaviors.

•	Knowing the biology behind the behavior will help you to realize that those who suffer from ADHD have not mastered developmentally appropriate skills; ie, communication, study skills and at times are lagging in maturity

				    True?		False?

Primary Symptomatology
•	Hyperactive-Impulsive Type
•	Hyperactivity In children
•	Inability to modulate locomotion; squirming , fidgeting, excessive climbing
•	Hyperactivity in Adults
•	Restlessness, irritability, difficulty relaxing

Hyperactive-Impulsive Type cont.

•	Impulsivity in children
•	Inability to moderate behaviors i.e. excessive talking, butting into conversations, invading others’ personal boundaries, low frustration tolerance
•	Impulsivity in Adults
•	Continue to be consistent talkers who have not learned to listen to others in a genuine way, tend to change jobs more frequently, have more divorces, traffic violations and substance abuse problems including nicotine, caffeine and overeating

Inattentive Type
•	In children:
•	Difficulties in  memory, listening, following directions, lack of follow through, persistence, transitioning between tasks, daydreaming.
•	In adults
•	Difficulty in memory, planning, organization, follow through in work and in family lives. Less likely to finish high school or college and tend to advance slower than their peers.
On the other hand!
•	If they can channel their energy, enthusiasm and love of novelty, they can become very successful in the workplace.

•	Studies show that about 1/3 of adults with ADHD can become entrepreneurs by their 30’s.

•	First Things First:  A look at a healthy brain and nervous system.
•	The human brain is the most complex structure on earth.
•	Comprised of
•	100 billion neurons
•	Connection with cells near and far
•	Can include up to 100 trillion connections
•	3.5 lb of gray and white matter the size of a grapefruit

•	Dynamic nature – changes constantly in response to environmental stimuli
•	Major Job – to reach and maintain Homeostasis, the regularity of the internal environment, and to integrate and modulate incoming information from our senses
•	Modulates incoming information to ascertain the bodies need for and level of response

Neuro-anatomical Impairments in ADHD
Neuro-anatomical Impairments in ADHD
•	Smaller anatomic areas and/or volumes in the following regions of the brain.  Some studies suggest as much as 7-10% below the healthy control samples:

Pet scan comparisons of brain waves
Neuro-anatomical Impairments in ADHD

•	Corpus Callosum
•	Prefrontal Cortex
•	Basal Ganglia
•	Cerebellum

Neuro-anatomical Impairments in ADHD
•	Locus Coeruleus
•	Reticular Activating System
•	Total White Matter Volume

Neuro-anatomical Impairments in ADHD
•	Corpus Callosum
•	the large bundle of axons which connect the two cerebral hemispheres. It disseminates information from the cerebral cortex on one side of the brain to the same region on the other side.
•	Prefrontal Cortex
•	Area of the brain that is devoted to many aspects of mature adult functioning such as judgment, reasoning, planning, rational thought, organization goal setting and follow through.
Neuro-anatomical Impairments in ADHD
•	Basal Ganglia
•	group of structures which coordinate movement; located in the forebrain (telencephalon)

•	Cerebellum
•	structure located in the back of the brain involved in central regulation of movement, such as basic movement, balance, and posture; comes from the latin word meaning "little brain"; is divided into two hemispheres and has a cortex 
Neuro-anatomical Impairments in ADHD
•	Locus Coeruleus
•	Noradrenergic system supplies Norepinephrine (NA) throughout the central nervous system. Involved in processing of relevant or salient information as well as highly involved in startle reactions, stress and panic.
•	Reticular Activating System
•	The RAS acts as the executive secretary conscious awareness. It is the chief gatekeeper that screens or filters the type of information that will be allowed to get through. 
Impairments in ADHD: Pictorial
Neurotransmitters related to important mental processes and adaptive behaviors
When it comes to neurochemistry

Wellness

=  Balance

•	The three major categories of substances that act as neurotransmitters are
•	Amino Acids
•	Peptides
•	Monamines

•	 Amino Acids 
•	Glutamic acid or Glutamate 	Workhorses
•	GABA						of the Brain
•	 Aspartic acid
•	Glycine

•	Peptides 
•	Vasopressin
•	 Somatostatin
•	 Neurotensin, etc.
•	The peptides perform specialized functions in the hypothalamus or act as co-factors elsewhere in the brain.

•	 Monoamines 
•	Norepinephrine, 
•	Dopamine 
•	 Serotonin 
•	Acetylcholine
•	The monoamines & acetylcholine perform specialized modulating functions and are often confined to specific structures. 

•	Dopamine
•	“Gusto” Neurotransmitter
•	 Implications in motivation, reward and risk taking
•	Predictive of locomotive activity

•	Norepinephrine
•	Responsible for sustained attention
•	Fight and Flight Reaction (Little Brain)
•	Prepares the body for action
•	increase the heart rate as well as blood pressure

•	Serotonin
•	Has been called the “Master neurotransmitter”
•	Has regulatory effects on other neurotrasmitters
•	Mood, appetite, concentration, memory, sexual function and arousal
ADHD brains lack neurochemical balance
•	Inattentive Type
	    	Norepinephrine		Daydreaming
		Dopamine			Memory Impairment
		Serotonin			Difficulty concentrating

•	Hyperactive-Impulsive Type
			Norepinephrine			Hyperactivity
			Dopamine				Impulsivity
			Serontonin				Restlessness
What’s Happening in the Field of Molecular Genetics?
Are those people related??
Family and Twin Studies
Genetic Contributions to Adhd
•	Several genes have been consistently found to be a associated with ADHD
•	Dopamine D4  (DRD4)
•	Dopamine Transporter Gene (DAT)
•	Found to be also impaired in 
•	Tourettes
•	Conduct Disorder
•	Obsessive-Compulsive Disorder
		
Genetic Contributions to Adhd
•	Dopamine D5 receptor gene  (DRD5)
•	Dopamine beta-hydoxylase gene (DBH)
•	Implicated in 
•	Decreased concentrations of dopamine
•	Upregulated postsynaptic dopamine
•	(decreased amount available in the synapse)
•	Extracellular concentrations of dopamine
•	Brain’s inability to modulate dopamine levels to control behaviors and mental processes

Knock out mice		
•	New advances in molecular genetics have enabled science to selectively “knock out” one gene in a sample of mice.   By observing and contrasting  generations of mice with and without a particular genetic influence behaviors can be observed, compared and contrasted.
Genetic Contributions to Adhd
•	Serotonin Transporter Gene (5HTTT)
•	Serotonn Receptor Gene (HTR1B)
•	Decreased concentrations of serotonin
•	Upregulated postsynaptic serotonin
•	(decreased amount available in the synapse)
•	Extracellular concentrations of serotonin
•	Brain’s inability to modulate serotonin levels to control behaviors and mental processes

Important note	
•	The genetic contribution to ADHD has been shown to be as high as 75% in some families, but!
•	Other possible causes can be:
•	Other psychiatric disorders in parents and first degree biological relatives
•	Substance use, abuse and dependency in mother, father and alcoholism and substance related disorders in families
•	Other medical problems that could have caused damage to the brain
Whew!!! How about a little review!
•	Review Flash Cards under Java Games
•	These will highlight the important aspects of the class and prepare you for the quiz.
•	Complete at least one more game, so that you can enjoy the review of this important information.  You will also greatly increase the chances of passing the quiz the first time!
•	You can also review this presentation as many times as you’d like.