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Doug Dallas

on 22 March 2014

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Transcript of ADD/ADHD Brain/SPECT

ADHD in Counseling
Counseling ADHD Information
ADD/ADHD Statistics

"Approximately 11% of children 4-17 years of age (6.4 Million) diagnosed with ADHD as of 2011" (CDC).

"The percentage of children with an ADHD diagnosis continues to increase, from 7.8% in 2003 to 9.5% in 2007 and to 11.0% in 2011." (CDC)

"Rates of ADHD diagnosis increased an average of 3% per year from 1997 to 2006 [Read article] and an average of approximately 5% per year from 2003 to 2011." (CDC)

ADHD found in every country where studied (Amen 20)

Under diagnosed in minorities and society

"Boys (13.2%) were more likely than girls (5.6%) to have ever been diagnosed with ADHD." (CDC)

"The average age of ADHD diagnosis was 7 years of age, but children reported by their parents as having more severe ADHD were diagnosed earlier."
Dr. Amen's 7 Types of ADHD
Type 1-
Classic ADHD
(hyperactivity, restlessness, and impulsivity)

Type 2-
Inattentive ADHD
(low motivation and low energy- More common in girls)

Type 3-
Over-Focused ADHD
(trouble shifting attention, argumentation, worrying, and high anterior cingulate activity within the brain)

Type 4-
Temporal Lobe ADHD
(anxiety, trouble reading, anger issues, headaches, and low temporal lobe activity)

Type 5-
Limbic ADHD
( low energy, low self-esteem, irritability, and high deep limbic activity)

Type 6-
Ring of Fire
(extreme moodiness, inflexibility, excessive talking, and overall increased activity across the cortex)

Type 7-
Anxious ADD
(disorganization, anxiety, tension, distractibility, and increased activity in the basal ganglia at rest or while concentrating) (Amen 2014c)
Medication of ADHD
3 Types of Chemicals in brain
(Attention, Motivation, Pleasure, Reward)
(Obssesions and Compulsions)

SPECT Imaging
-SPECT (single photon emission computed tomography)

- SPECT gives three pieces of information- healthy activity, too little activity, or too much activity

-Evaluates blood flow and activity patterns of the brain.

-SPECT looks at function as opposed to CAT and MRI's, which are anatomy studies.

-SPECT shows the function or dysfunction of specific brain regions such as the prefrontal cortex (PFC), Basal Gaglia, temporal lobe, and Cerebellum)

Diagnostic Criteria
Treatment 1- Psychostimulants
Stimulant Medication- Long Acting
Ritalin LA (Methylphenidate)
Adderall XR (Amphetamine-Dextroamphetamine)
Focalin XR (Dexmethylphenidate)
Metadate CD (Methylphenidate)
Daytrana (Methylphenidate)
Concerta (Methylphenidate)
Vyvanese (Lisdexamfetamine)

Non-stimulant Medication- Most common
Strattera (Atomoxetine)
1 Has hard time paying close attention to details.
2 Shows difficulty maintaining attention in activities/tasks.
3 Mind seems elsewhere or does not seem to listen when spoken too.
4 Has difficulty following instruction, finishing tasks, and easily sidetracked.
5 Not organized, poor time management, and difficulty organizing activities and tasks.
6 Often avoids or dislikes activities/tasks that require sustained mental effort, such as reviewing papers, forms, and reports.
7 Losers or misplaces things such as keys, paperwork, books, and school materials
8 Easily distracted by things happening/stimuli
9 Often forgets to pay bills, complete chores, or keep appointments.
Ineffective treatment or left untreated ADHD
"33 Percent never finish high school
52 percent of untreated teens and adults abuse alcohol and drugs
19 Percent smoke
46 Percent of untreated boys will be arrested for a felony by age sixteen
21-25 Percent of inmates have been found to have ADHD
ADHD is found in every country where studied"
(Amen, Healing ADD, P. XXXV)

Jean King, Doug
Dallas, Andrea Fillipps,
and Roxanne Faber

Behavior Therapy/ Behavior Modification
structure time, predictability, increase positive attention, reward systems, clear consequences
Family Therapy
Problem solving communication therapy
Behavioral Parent Training (BPT)
Works with the parent to establish clear structure and discipline at home
Counseling ADHD Adults

How Counselors can help

Aid in initial diagnosis and assessment
Offer counseling, behavior management, problem solving
Refer client to a doctor who can prescribe medication
Provide further literature & resources

When coupled with medication, counseling therapy has proved extremely successful in treating ADHD.

Compared to individuals treating ADHD solely through medication, individuals who receive counseling exhibit fewer ADHD symptoms.

SPECT is a nuclear medicine imagaing test
that used a radioactive material known as
a tracer to see how blood is flowing with
activity or no activty (Mayfield)
High likelihood of working with ADHD Clients
ADHD can cause functional impairments in daily life
High Comorbidity- ADHD clients are likely to also suffer from:
Learning disabilities
Substance abuse
Mood disorders
Behavioral disorders
Counseling ADHD Children/ Adolescents
Cognitive Behavior Therapy (CBT)
Change the way you think to change behavior
CBT Counselors:
utilize homework
teach skills to cope with symptoms
work to prevent dysfunctional thinking
educate the client about ADHD

ADHD is a valid psychiatric disorder which requires treatment.

Dr Amen believes, "Treatment needs to be tailored to individual brains and not clusters of symptoms"
SPECT Brain Scans

-A chemical in the brain that is naturally produced and helps concentration, sustained attention, motivation, and working memory. Ritalin/Concerta/Adderall works by raising dopamine in the brain.
Brain Chemistry
Methylphenidate and Dexmethylphenidate drugs work by increasing dopamine which helps with attention and focus.
Amphetamine, Dextroamphetamine, and Lisdexamfetamine drugs work by blocking the removal of dopamine and norepinephrine.
Atomextine drugs target the prefrontral cortex to increase dopamine and norepinephrine.
- Released naturally by the nerve cells.. Responsible for bodys reaction to stressful situations.
- Synthesized in the brain and acts as a neurotransmitter sending chemical messages from one area of the brain to another. Mood, appetite, sleep, and sexual behavior are some of the things affected.
"A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development as characterized by (1) and/or (2)" (American Psychiatric Publishing, 2013, p. 59).
History of ADHD

ADD/ADHD referenced as early as 17th Century by philosopher John Locke (Amen)

Start of 20th century Sir George Frederic Still started to label children "Morally Defective" who displayed symptoms of ADHD.
In the 1930's children began to be labeled with minimal brain damage.
1980 the Diagnostic and Statistical Manual (DSM-II) listed the official term as ADD for the first time.
Every version of the DSM since has listed the core symptons of ADD but with a different name since. (Amen)
ADHD Definition
(1) Inattention
Six or more symptoms and at least six months of displaying symptoms for adults. Children 16 and younger need to show at leas five symptoms.
(2) Hyperactivity and impulsivity
Six or more symptoms and at least six months of displaying symptoms for adults. Children 16 and younger need to show at least five symptoms.
1 Taps hands, fidgets feet, squirms
2 Often cannot remain seated for long
3 Often feels restless and with children runs about where not appropriate.
4 Often cannot play quietly
5 Restless, on the go, and hard to stay in one place.
6 Will often talk excessively.
7 Blurts out answers, cannot wait turn, finishes sentences
8 Often has a hard time waiting his or her turn
9 Will often interrupt other, take over, not ask.

17Th Century
20Th Century- 1902
DSM-II begins to label "Hyperkinetic Reaction of Childhood"
DSM IV lists three subtypes of ADHD.
Dr. Amen believes in seven types of ADHD based on SPECT imaging of blood flow to the brain.
Amen, D. G. (2014a, January 23). A very busy brain [Web log message]. Retrieved from http://www.amenclinics.com/dr-amen/blog/2014/01/a-very-busy-brain week-6-of 7-ring-of-fire-add/

Amen, D. G. (2013a). Healing ADD: The breakthrough program that allows you to see and heal
the seven types of ADD. New York, New York: The Berkley Publishing Group.

Amen, D. G. (2013c, December 19). Get to know the ADD types [Web log message]. Retrieved from http://www.amenclinics.com/dr-amen/blog/2013/12/get-to-know theadd-types-week-1-classic-add/

Amen, D. G., Hanks, C., & Prunella, J. (2008). Preliminary evidence differentiating ADHD using brain SPECT imaging in older patients. Journal of Psychoactive Drugs, 40(2), 139-146. doi: 10.1080/02791072.2008.10400623

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.). Arlington, VA: American Psychiatric Publishing

Centers for Disease Control and Prevention. (2014, February 21). Attention-deficit/hyperactivity
disorder (ADHD). Retrieved from http://www.cdc.gov/ncbddd/adhd/index.html

Mayfield Clinic. (2013). SPECT (single photon emission computed tomography) scan.
Retrieved from http://www.mayfieldclinic.com/PE-SPECT.htm

Seidman, L. (2006). Neuropsychological functioning in people with ADHD across the lifespan. Clinical Psychology Review, 26(4), 466-485. Retrieved from http://www. sciencedirect.com/science/article/pii/S027273586000055

Spencer, T. J. (2004). ADHD treatment across the life cycle. The Journal of Clinical Psychiatry, 65(3), 22-26. doi: 10.1016/j.cpr.2006.01.004

Thapar, A., Cooper, M., Jefferies, R., & Stergiakouli, E. (2011). What causes attention deficit hyperactivity disorder? Archives of Diseases in Childhood, (97), 260-265.
doi: 10.1136/archdischild-2011-300482

What is ADHD. (2001). American Family Physician, 64(5), 831-832. Retrieved from http://www.aafp.org/afp/2001/0901/p831.html

Dr. Amen
Role of Counselors
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