HCQU NORTHWEST ADHD & INTELLECTUAL DISABILTIY
HOME STUDY, 1 HOUR
ATTENTION DEFICIT— HYPERACTIVITY DISORDER
ADD — Attention Deficit tention may wander off delayed gratification. Disorder task and seem to lack Although not diagnostic of persistence. They have ADHD, it is not uncom- ADHD — Attention Defi- difficulty maintaining focus mon to see the following cit - Hyperactivity Disor- on tasks and conversa- Associated Features: low der tions, and often miss im- frustration tolerance, irrita- portant details. They are bility, and mood swings. According to the DSM-5, typically disorganized — ADHD is defined as “A losing things and forget- ADHD is NOT resistance persistent pattern of inat- ting daily activities. to tasks due to refusal to tention and/or hyperactivi- conform to the demands People experiencing Hy- ty-impulsivity that inter- of others. For the person peractivity and Impulsivity feres with functioning or with ADHD, tasks are re- can appear “restless,” ex- development…” For diag- sisted due to the required cessively moving or talk- nosis, symptoms must be effort (and the person’s ing when it is not appro- present before the age of inability) to focus. People priate. They have a diffi- 12 and interfere with the with ADHD do not typical- cult time waiting their turn person’s quality of life in ly engage in serious ag- in activities and conversa- two or more settings for a gression toward others or tions. They often engage minimum of six months. self-injury. A person may display a in potentially harmful ac- “Predominantly inatten- tivities due to an inability People with ADHD may tive,” “Predominantly hy- to think ahead to potential be perceived by others peractive / impulsive,” or consequences. They typi- as: “lazy,” “irresponsible,” “Combined” presentation. cally perform better when or “un-co-operative.” rewards are immediate, People experiencing Inat- as they have trouble with
ADHD IN ADULTS For many years it was believed that clude: anxiety, chronic boredom, ADHD was a disorder of childhood and chronic lateness & forgetfulness, diffi- adolescence and resolved by adulthood. culty controlling anger, impulsiveness, Recently, we have begun to recognize low frustration tolerance, low self- that ADHD can persist into adulthood. esteem, poor organizational skills, rela- (NOTE: All adults with ADHD had tionship problems, and substance use/ ADHD as children, whether or not it abuse. was diagnosed). Symptoms may vary in severity, and Because of the different types of de- with the situation. Some may seek mands in the work (vs. school) environ- stimulation while others avoid it. Some ment, symptoms may present a bit dif- may be withdrawn while others may be ferently. According to webmd.com, overly social. adult ADHD behaviors / difficulties in- HCQU NORTHWEST PAGE 2
ADHD AND THE ID POPULATION
There is a great deal of dis- Although one study showed of ID. “ADHD in adults parity among the literature that rates of ADHD dropped Children with ID and ADHD with ID may have as to the prevalence of as children with ID transi- also have shown higher a more severe ADHD in people with Intel- tioned into adulthood, others rates of co-occurring Oppo- lectual Disability. Some of have put the prevalence rate presentation and sitional Defiant Disorder and this appears to be related to for adults with ID at 17 to 52 Conduct Disorder compared an uneven and less the lack of diagnostic tools percent. favorable pattern to ADHD children without ID that are geared toward this What does appear more (Journal of Pediatrics, of improvement population. Additionally, the clear is that symptoms of 2013). across the lifespan symptoms of ADHD can be ADHD are more serious and Because both ID and ADHD in comparison similar to the presentation of enduring in people with ID, the ID itself. affect cognitive functioning with adults and may be less responsive (such as memory; the ability without ID.” In children with ID, it is esti- to the typical medications to plan, problem-solve, and mated that 25 to 40 percent (with an increased suscepti- make decisions; and atten- — Journal of Intellectual have ADHD (American bility to side effects). The Disability Research, 2010 tion itself), some refer to a Academy of Pediatrics, severity of ADHD symptoms “double deficit,” in that the 2012). correlates with the severity presence of both ID and
RISK FACTORS, CO-OCCURRENCE, AND RULE-OUTS ADHD has a strong genetic component, several genetic syndromes, including: may also co-occur, particularly in adults. so presence in a blood relative increases Klinefelter Syndrome, Williams Syn- The symptoms of ADHD can also be one’s risk. Additional risk factors in- drome, Turner Syndrome, Phenylke- mimicked by other disorders. Clinicians clude: exposure to nicotine, alcohol, tonuria, Velocardiofacial Syndrome, neu- may attempt to rule out some of these drugs, or environmental poisons in utero; rofibromatosis, and Tuberous Sclerosis common conditions before diagnosing premature birth or very low birth Complex. The highest prevalence is in ADHD: Autism Spectrum Disorder*, weight; childhood exposure to environ- Fragile X Syndrome, with almost 3/4 of Hypothyroidism, Iron Deficiency Ane- mental toxins (ex. lead); and a history of all boys with FXS diagnosed with ADHD. mia, Lead Toxicity, nutritional deficien- child abuse, neglect, and/or multiple In addition to genetic syndromes, ADHD cies, food allergies, Seizure Disorder, foster placements. Additionally, the risk commonly co-occurs with other psychiat- sleep disorders, and sensory disorders. for males to have ADHD is twice that of ric conditions, including mood disorders, females. *may also co-occur, but there is disparity anxiety disorders, and personality disor- as to prevalence rates ADHD presentations have been linked to ders. Intermittent Explosive Disorder
HYPERFOCUS
Many supporters of people The phenomenon of hyperfo- with ADHD are confused by cus has led many ADHD ex- “[People who hyperfo- the person’s capacity to perts to point to cus] aren’t being diso- “hyperfocus” on certain activi- “dysregulation” (vs. deficit) of bedient. Their brains ties. When people with attention. It is more a matter ADHD are engaged in some- of difficulty “shifting gears,” just aren’t registering thing they find interesting, especially when the person is what you’re say- they are often able to focus doing something he/she en- ing...It’s almost like quite well. In fact, they often joys. Hyperfocus commonly pulling someone out focus so intensely that they do occurs around video games not notice anything else. and/or the computer & inter- of a dream.” They may not even respond to net, but can occur with any — Kathleen Nadeau, Ph.D their own name. desirable activity. PAGE 3 HCQU NORTHWEST
DIAGNOSIS
Diagnosing ADHD in an adult with Symptom presentation and se- mance. ID can be challenging. Distin- verity must be considered with Where are symptoms most like- guishing ADHD from other medical regard to the person’s develop- ly to occur? (ADHD symptoms or psychiatric conditions as well as mental level (vs. chronological occur more often in group set- from the ID itself can make it diffi- age) — be prepared to help the tings) cult for clinicians to determine why clinician understand the per- certain symptoms are present. As son’s strengths and limitations. Since ADHD must be present you provide the information to the (even if not diagnosed) in child- Provide information from peo- hood, ask people who knew the diagnosing clinician, there are ple who have observed the per- some helpful things to be sure to person when he/she was young son in multiple settings, includ- or review records for past diag- note: ing information on work perfor- noses or possible symptoms.
TREATMENT
The most commonly prescribed medications for ADHD are stimulants. These in- “...there is no clude methylphenidate (Ritalin, Concerta, etc.), dextroamphetamine (Dexedrine), dextroamphetamine-amphetamine (Adderall), and lisdexamfetamine (Vyvanse). research to Many are available in short- or long-acting forms. They are considered controlled demonstrate the substances due to their high potential for abuse. They tend to work quickly. effectiveness of Atomoxetine (Strattera) and anti-depressants (ex. Wellbutrin) have been known to risperidone for work, but typically take much longer to reach full effect. ADHD in People with ID in particular are sometimes prescribed the anti-psychotic risperi- people with done (Risperdal) to treat ADHD symptoms, although this is not supported by the intellectual current research. disability…” Many believe that the symptoms of ADHD are the result of metabolic deficiencies (ex. hypothyroidism, Vitamin B12 deficiency) or ingestion of various food additives —Dr. Alex (ex. dyes, nitrates, etc.). Some parents have reported successful treatment of their Thomson ADHD child’s symptoms via elimination of certain additives (thus eliminating the (2009) need for prescription medications).
PROVIDING SUPPORT
One of the most important things we can do to support a person with ADHD is to help them find ways to organize themselves. For example, a daily To-Do List (developed with the person) can help someone stay on track. R eminders such as sticky notes, appointment books, and alarms may also be useful. Help the person develop a daily routine for activity and possessions (ex. putting personal items in the same place). If the person appears to be hyperfocused, you may have to do something to get the person’s attention (break the “trance”). You might tap him on the shoulder or wave your hand in front of him. NEVER interrupt angrily. You might need to allow a few minutes for the person to “switch gears.” Teaching people about their diagnosis can help them understand why they do the things they do and in the process, help us as well. Supporting a person with ADHD can be frustrating — it can seem as if many of the symptoms are voluntary behavior (“He’s ignoring me” “She doesn’t have any trouble completing things she wants to do”). Like all of us, people with ADHD are doing the best they can with the abilities they have. Sometimes their brains betray them. HCQU NORTHWEST ADHD TEST
Name: ______Date: ______Role/Title: ______Agency: ______Please provide contact information (email address, fax number, or mailing address) where you would like your certificate to be sent: ______You must submit your completed test, with at least a score of 80%, to receive 1 hour of training credit for this course. To submit via fax, please fax the test and evaluation to 814-728-8887. Please fax only the test and evaluation, not the entire training packet. To submit via email, please send an email to [email protected]. Please put “ADHD Test” in the subject line, and the numbers 1—5, along with your answers, in the body of the email, OR scan the test and evaluations pages and email as attachments. To submit via mail, send the test and evaluation pages to: Milestone HCQU NW, 247 Hospital Drive, Warren PA 16365.
1. ADHD does not begin in adulthood. True False
2. A person can have either Attention Deficit OR Hyperactivity, but not both.
True False
3. It can be difficult to distinguish symptoms of ADHD from those of Intellectual Disability.
True False
4. People with more severe levels of Intellectual Disability typically experience more severe symptoms of ADHD. True False 5. The best way to pull someone with ADHD out of hyperfocus is to yell his or her name as loudly as you can. True False
For additional information, check out the following: www.chadd.org www.cdc.gov/ncbddd/adhd/ www.webmd.com/add-adhd/guide/adhd- medication-chart For a great description of personal experience with ADHD see: www.tickld.com/funny/t/755718 HCQU NORTHWEST
EVALUATION OF TRAINING
Training Title: ADHD Date:
Direct Support Professional Provider Administrator/Supervisor
Program Specialist Provider Clinical Staff
Consumer/Self-Advocate Family Member
Support Coordinator Support Coordinator Supervisor
PCH Staff/Administrator County MH/MR/IDD
FLP/LSP Other (please list):
Please circle your PRIMARY reason for completing this home-study training: It’s mandatory interested in subject matter need training hours convenience
Please circle the best response to each question. 5 = Strongly Agree 4 = Agree 3 = Undecided 2 = Disagree 1 = Strongly Disagree
1. As a result of this training, I have increased my knowledge. 5 4 3 2 1
2. I learned something I can use in my own situation. 5 4 3 2 1
3. This training provided needed information. 5 4 3 2 1
4. The training material was helpful and effective. 5 4 3 2 1
5. Overall, I am satisfied with this training. 5 4 3 2 1
6. I am glad I completed this training. 5 4 3 2 1
Suggestions for improvement:
Additional information I feel should have been included in this training:
I would like to see these topics/conditions developed into home-study trainings: