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Dr Russell A Barkley ADHD-The 30 Essential Ideas everyone needs to know

25 Episodes
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Question: Lately a connection seems to have been found between ADHD and Bi-Polar disorder, what are your thoughts on co-morbidity and misdiagnosis?
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Question: What are your thoughts on Cogmed to increase working memory?
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Question: What is the best way to deal with teaches and other parents when your child has acted out emotionally and created a negative situation?
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Get your own ADHD treated, you have roughly a 1/3rd chance of being ADHD yourself. You need to get your ADHD treated since it dramatically affects your own life and the life of your kids.
Practice Forgiveness and Enjoy the Ride
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Treatments that you should avoid for we know they do not work.
Diet Modification, such as removing colorings, preservatives, and flavorings
Antioxidants do not work
Fish Oils do not work
Omega 3s do not work
Sensory Integration Training does not work
Play Therapy does not treat ADHD it only helps relieve stress
Self Control Training does not work with children. It has success with older teens and adults if they are medicated
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ADHD Medications Myths
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ADHD Medications
Two types of Stimulants
Methylphenidate (Concerta, Ritalin, Metadate, Methylin, Focalin) type Stimulant
Amphetamine Salts (Adderall, Vyvanse, Dexedrine, Dextrostrat) type Stimulants
Non Stimulant Drugs
Strattera (Atomoxetine) - A NRI - it affects the norepinephrine and dopamine levels between the brain synapses
Alpha 2 Agonists drugs Intuniv (Guanfacine) and Kapvay (Clonidine) these drugs are anti-hypertensive drugs (blood pressure meds) that trigger a neurotransmitter receptor called the Alpha 2 receptor (Alpha 2 receptor can be triggered by norepinephrine
The Five Delivery Mechanisms (The Five Ps)
Pill
Pump
Pellet
Patch
Pro Drug
Note there are other meds that are used OFF LABEL for ADHD. The meds listed above are the first line treatments, and you only use the off label meds if the person can't tolerate the side effects of the primary meds, or if they do not work for some reason.
TALK TO YOUR DOCTOR!!!
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Transition Planning
Positive and Negative Reinforcement
Review the system out loud with your kid, when he makes a mistake help him figure out where he messed up for his sake, and then shut up. You are wanting to help the kid establish hindsight, you are not trying to beat him over the head for it is in the past, and there is only so much hindsight you can instill into an ADHD person for it is not knowledge, it is the use of knowledge in everyday life.
Behavior Monitoring Card
Token Reward System, making it into a currency makes it easier to consistently do and it is easier to make the ADHD person realize these points which you get instantly can be converted into long term rewards. It is now like a video game.
Reactive Parenting works worse, and it is more stressful.
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More Accountability
More Predictability
More Immediate Results with Instant Consequences both Positive and Negative
Act Don't Yak
Break the Work into Small Pieces
Pomodoro Technique, Small Chunks, Frequent Breaks, Positive Reinforcement when Success Occurs
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You are a shepherd not an engineer. You do not get to design your child. Most of the things that will affect your child and help him turn into the person he will be are out of your control, so stop trying to control them for you will only fail. Instead recognize the amazing power you do have and focus only on that. You get to choose the environment your child gets to live in and experience life. You are a shepherd not an engineer.
You can not make a sheep into a sheep dog, no matter of wanting it, or throwing stuff at it will make an animal change species. Given proper motivation and the right environment though and that sheep can grow up and be a ram, and still protect the rest of the herd.
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The 3 Roles Every Parent Must Play (They need to do this).
Be a scientific parent. Read widely and educate yourself on ADHD. Experiment with your kid since not all treatments work with all kids, keep on trying till you perfect it. Be skeptical for there is a lot of bull shit out there on the internet and especially about ADHD.
Be an executive parent and take charge, make stuff happen, you are your parent's guardian and you need to do your best to make things happen and that means making yourself the president, the executive, the decider.
Be an advocate parent. Make stuff happen for your kid.
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The 30% Rule, the real executive age (the emotional age) of the child. They may know and have skills of their true age, but they can only use those skills like a person who is 30% younger, unless the environment is arranged in a way where they do not have a performance disorder.
ADHD kids and driving
4 Necessary Components for Effective Treatment
Get a Good Evaluation to make sure you are ADHD and to figure out all the other comorbidities you may have.
Families need to educate themselves.
Medication is the most effective treatment, Medication + Behavior/Environment changes are better. Only 20% of ADHD people can prosper as kids without medication due to changes in the environment/behavior changes, and even those 20% do better with medication plus everything else.
Make accommodations. Create prosthetics, artificial advices to help the person show what they know.
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ADHD people have impairments of all aspects of life. Barkley lists many of them.
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Working Memory problem? Then use external memory, paper and pen, sticky notes, lists, calendars etc
Hard to keep complicated things in working memory? Then break the big problem into small problems. Use external devices such as paper to pen to help plot your plans out. Use the notes to make a story.
Problems with self motivation? Figure out ways to create external motivation.
Other problems that are not ADHD, you probably have a comorbid condition which you need to treat as well.
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Stop teaching so many skills. More skills will not fix the problem.
Instead organize the environment and your behavior so your disability is less debilitating.
ADHD is a disorder of self regulation
ADHD people have no problem interacting with the environment if the consequences are NOW and immediate. Thus create external stimuli and forces to replace what should be internal motivation and stimuli.
You can never out train ADHD, no amount of training will change ADHD. So stop trying to fix ADHD by doing one more thing.
Instead try to manage ADHD, to prevent secondary harms like failure. You do this by making it easier for the ADHD person to function by making them interacting with external factors and not internal ones.
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ADHD is time blindness, no sense of time, it is always now.
ADHD people's brains on an instinctual and emotional level can't prioritize to the future since the now is so important.
A story of a lawnmower.
Nearsightednessof Time
Pyramids of Behavior, Behavior in a Hierachy
Back of the Brain is Knowledge, the front of the brain is how you put that knowledge to use.
ADHD is not a question of what you know, you may be the smartest person on the planet but if you have ADHD you will do stupid things (doing stupid things is different than being stupid). ADHD is a performance disorder about using that knowledge.
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Gene and Environmental Interaction
What does not cause ADHD
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What we know about ADHD and Genetics
Genes that Barkley Showed but it is not clear on the slide since we barely see it.
DRD4 specific gene variants, dopamine receptor
DRD2 specific gene variants, dopamine receptor
DAT1 specific gene variants, dopamine reuptake transporter
DBH specific gene variants, enzyme that is involved in the processing of monoamines neurotransmitters
MAO-A specific gene variants, enzyme that plays a role of clean up and maintenance of monoamines neurotransmitters
LPHN3 (latrophillin gene) Gene that is connected to the G-Protein Receptors, critical part of signal transduction.
Barkley goes in more detail on his website here in this lecture
http://adhdlectures.com/lecture-view.php?LectureID=13
Note these are not all the genes that are connected to ADHD and are known, just some of them.
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ADHD and Causation
Barkley explains the percent of ADHD that is genetic, and the percent that is environmental.
The Five Regions of the brain that are smaller with people that have the genetic cause of ADHD
Right Frontal Lobe (Orbital Prefrontal Cortex)
Basal Ganglia (Mainly Striatum and Globus Pallidum)
Cerebellum (central vermis area, more on right side)
Anterior Cingulate Cortex
Corpus Callosum (Primary Anterior Splenium)
ADHD children also have a 2 to 3 year delay in the growth and the size of these parts of the brain. Eventually as adults the size will for the most part equalize and only be 3 to 8% smaller.
Even though these parts of the brain are barely smaller, it is the electrical activity and how the brain that is wired that really cause the ADHD. Not the size of the parts but how those parts are wired and do they generate enough electrical activity to adequaltely use those parts of the brain in daily life.
Current medical imaging can't diagnose individuals for the size difference is too close and too subtle to normal. Yet look at hundreds or thousands of scans and patterns emerge.
The importance of twin studies and what twin studies tell us about causation.
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Dr Barkley details what may be a specific subtype of ADHD or a different disorder that needs to be separated from ADHD in the DSM. This disorder in the mainstream psychological literature is called Sluggish Cognitive Tempo. Barkley things Concentration Deficit Disorder is a better name, yet he uses SCT since it is the name that is the most popular and used.
Barkley compares SCT to traditional ADHD (aka ADHD combined). Note you can have both as comorbid conditions.
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