Welcome to ADD Health & Wellness Centers, Inc . April 15 th , 2007

Presenters Theresa Cerulli, MD – Chief Medical Officer Theresa Lavoie, PhD – Director Psychological Services Gillian Botha-Harvey – Regional Manager

Our Commitment & Team Approach Our mission is to provide a comprehensive array of professional services for adults and children with attentional disorders such as ADHD, coexisting conditions, and learning disorders that will help them lead happier, more productive lives through a balanced, integrative and holistic, asset-based treatment model.

What is ADHD? 1930’s Minimal Brain Dysfunction 1968 DSM II Hyperkinetic reaction of Childhood 1994 DSM-IV ADHD: Predominately inattentive type Predominately hyperactive type Combined type 1980 1987 DSM III Attention Deficit + or - Hyperactivity DSM III-R Attention Deficit Hyperactivity Disorder

Three Subtypes of ADHD DSM-IV Predominately Inattentive Type (30-40%) ADD Predominately Hyperactive Type (10%) Combined Type (50-60%)

DSM-IV

Predominately Inattentive Type (30-40%) ADD

Predominately Hyperactive Type (10%)

Combined Type (50-60%)

Symptoms of Inattention Often: Makes careless mistakes Has difficulty sustaining attention Is easily distracted Distracted from tasks by background noises ignored by others Avoids tasks requiring sustained attention Loses things Has difficulty paying attention to conversations Is forgetful Doesn’t seem to listen Fails to finish tasks Shifts from one uncompleted activity to another

Makes careless mistakes

Has difficulty sustaining attention

Is easily distracted

Distracted from tasks by background noises ignored by others

Avoids tasks requiring sustained attention

Loses things

Has difficulty paying attention to conversations

Is forgetful

Doesn’t seem to listen

Fails to finish tasks

Shifts from one uncompleted activity to another

Symptoms of Hyperactivity/Impulsivity Often: Unable to stay seated at mealtime, watching TV, or doing homework Cannot sit still and listen to a story Fidgets, shakes feet & legs Excessive running, climbing, and jumping Has difficulty playing quietly Constantly “on the go” Talks excessively Has difficulty awaiting his turn-impatient Blurts out answers Interrupts or intrudes Makes excessive noise when engaging in quiet activities

Unable to stay seated at mealtime, watching TV, or doing homework

Cannot sit still and listen to a story

Fidgets, shakes feet & legs

Excessive running, climbing, and jumping

Has difficulty playing quietly

Constantly “on the go”

Talks excessively

Has difficulty awaiting his turn-impatient

Blurts out answers

Interrupts or intrudes

Makes excessive noise when engaging in quiet activities

ADHD & Executive Functioning Executive functioning refers to the ability to demonstrate knowledge and is impacted by: 1. Demands and expectations at a given time: Middle school vs. High school vs. College Single vs. Married vs. Becoming a Parent Career Responsibilities 2. Learned strategies: Time management systems Strategies for memory Choosing the best fit academically and professionally 3. Support by a spouse or parent in regulating, monitoring, and structuring of the environment.

Executive functioning refers to the ability to demonstrate knowledge and is impacted by:

1. Demands and expectations at a given time:

Middle school vs. High school vs. College

Single vs. Married vs. Becoming a Parent

Career Responsibilities

2. Learned strategies:

Time management systems

Strategies for memory

Choosing the best fit academically and professionally

3. Support by a spouse or parent in regulating, monitoring,

and structuring of the environment.

Doesn’t everyone have ADHD? The differences are that people with ADHD experience a greater severity and higher frequency of symptoms compared to the general population AND these symptoms are significantly impacting their daily functioning. Our comprehensive evaluation is critical because it allows us to compare an individual (adult or child) who questions ADHD with a “normative sample” which refers to a large sampling of peers the same age from the general population.

The differences are that people with ADHD experience a greater severity and higher frequency of symptoms compared to the general population AND these symptoms are significantly impacting their daily functioning.

Our comprehensive evaluation is critical because it allows us to compare an individual (adult or child) who questions ADHD with a “normative sample” which refers to a large sampling of peers the same age from the general population.

Myths About ADHD He is just lazy and unmotivated. Adults don’t have ADHD. Treatment for ADHD will cure it. The goal is to get off medication as soon as possible. He focuses on video games for hours. He can’t have ADHD. ADHD is caused by poor parenting. If I just try harder .....

He is just lazy and unmotivated.

Adults don’t have ADHD.

Treatment for ADHD will cure it. The goal is to get off medication as soon as possible.

He focuses on video games for hours. He can’t have ADHD.

ADHD is caused by poor parenting.

If I just try harder .....

ADHD Prevalence Rates ADULTS ADHD affects 4 - 5% of the adult population Only 2 of 9 million adults are currently diagnosed Half of children with ADHD still meet full criteria in adulthood Of the adults diagnosed with ADHD, very few are aware of treatment options other than medication CHILDREN 7 - 8% of school aged children or 4.5 million children are affected by ADHD 67% of children with ADHD are treated by their primary care physician with medication only and receive no additional education, therapy, coaching, academic guidance, or support

ADULTS

ADHD affects 4 - 5% of the adult population

Only 2 of 9 million adults are currently diagnosed

Half of children with ADHD still meet full criteria in adulthood

Of the adults diagnosed with ADHD, very few are aware of treatment options other than medication

CHILDREN

7 - 8% of school aged children or 4.5 million children are affected by ADHD

67% of children with ADHD are treated by their primary care physician with medication only and receive no additional education, therapy, coaching, academic guidance, or support

ADHD Untreated

Comorbidities with ADHD

ADDH&W - A Team Approach

ADD Health & Wellness How Are We Different? We thought to ask you. Extensive History Questionnaire and Rating Scales We ask others too . Interview with patient and family. Collaborative data from school, parents, doctors, teachers, and spouse We’re objective . Attentional Testing or Neuropsychological Testing We give results . Review Testing. Non-Medication and holistic approach We’re integrated . Cutting-edge, Latest therapies, Multimodal team approach We prove client success . Outcome Database to measure client results

We thought to ask you. Extensive History Questionnaire and Rating Scales

We ask others too . Interview with patient and family. Collaborative data from school, parents, doctors, teachers, and spouse

We’re objective . Attentional Testing or Neuropsychological Testing

We give results . Review Testing. Non-Medication and holistic approach

We’re integrated . Cutting-edge, Latest therapies, Multimodal team approach

We prove client success . Outcome Database to measure client results

Attentional Assessment State of the Art Evaluation of Attention and Executive Functioning Areas of Attention Assessed in Adults and Children: Auditory Attention (Simple and Complex) Visual Spatial Attention (Simple and Complex) Divided Attention The Ability to Shift Attention Sustained Attention Areas of Executive Functioning Assessed: Working Memory Organization Planning Impulsivity Distractibility Problem-Solving

Attentional Assessment

State of the Art Evaluation of Attention and Executive Functioning

Areas of Attention Assessed in Adults and Children:

Auditory Attention (Simple and Complex)

Visual Spatial Attention (Simple and Complex)

Divided Attention

The Ability to Shift Attention

Sustained Attention

Areas of Executive Functioning Assessed:

Working Memory

Organization

Planning

Impulsivity

Distractibility

Problem-Solving

ADHD is Frequently Associated with Learning Disabilities ADHD is associated with an extremely high rate of coexisting psychiatric conditions such as depression and anxiety and is frequently accompanied by a learning disability. Language disorders, reading disorders, and reduced processing speed frequently co-occur with ADHD. In one report, 45% of children with ADHD had at least one element of language impairment

ADHD is associated with an extremely high rate of coexisting psychiatric conditions such as depression and anxiety and is frequently accompanied by a learning disability.

Language disorders, reading disorders, and reduced processing speed frequently co-occur with ADHD. In one report, 45% of children with ADHD had at least one element of language impairment

What is a Neuropsychological Evaluation? Attentional Assessment PLUS: IQ testing Language processing Visual/spatial Skills Memory Learning style Speed of processing Academic Fine motor skills Comprehensive review of all previous testing, I.E.P’s and school accommodations.

Attentional Assessment PLUS:

IQ testing

Language processing

Visual/spatial Skills

Memory

Learning style

Speed of processing

Academic

Fine motor skills

Comprehensive review of all previous testing, I.E.P’s and school accommodations.

Treatment Options Who does ADHD impact?

Treatment Options

Treatment Services Primary model : Take 2 ritalin and call me next month? Our Integrated ADHD Treatment Model : Emphasis on Patient Education, Family, Career, and School Support Individual Cognitive and Behavioral Therapy and Relaxation Training ADHD Coaching for Adults and Children Support and Strategies Focused Groups for Adults Social Skills Groups for Children, Adolescent Groups Medication Management Complimentary & Alternative Therapies Nutritional Counseling, Supplementation

Primary model : Take 2 ritalin and call me next month?

Our Integrated ADHD Treatment Model :

Emphasis on Patient Education, Family, Career, and School Support

Individual Cognitive and Behavioral Therapy and Relaxation Training

ADHD Coaching for Adults and Children

Support and Strategies Focused Groups for Adults

Social Skills Groups for Children, Adolescent Groups

Medication Management

Complimentary & Alternative Therapies

Nutritional Counseling, Supplementation

Child / Adolescent Supports: We Address Specific Symptoms for Children and Teens: Attention in the classroom and during sports practice Completing work on time Difficulty memorizing facts Friendships, social skills training, anger management Study skills and Procrastination Organization of school materials Focus on assets/strengths Mindfulness training helpful in reducing stress * It is critical to address the impact of symptoms on self-esteem and any co-occurring symptoms of depression or anxiety.

We Address Specific Symptoms for Children and Teens:

Attention in the classroom and during sports practice

Completing work on time

Difficulty memorizing facts

Friendships, social skills training, anger management

Study skills and Procrastination

Organization of school materials

Focus on assets/strengths

Mindfulness training helpful in reducing stress

* It is critical to address the impact of symptoms on self-esteem and any co-occurring symptoms of depression or anxiety.

Adult Supports Learn Tools for Success to address time management , procrastination, organization, and increasing attention, and improving memory. Cognitive Therapy addressing self-esteem, well-being, and any co-occurring symptoms of anxiety or depression. Group Therapy , social support, strategies and skills training with others, and techniques for self-care. Home-Life Strategies , mindfulness, relaxation techniques for reducing stress and anxiety. Workplace Strategies , employer accommodations and career choices Couples Therapy educating couples together about ADHD and its impact on relationships, finances, and family life.

Learn Tools for Success to address time management , procrastination, organization, and increasing attention, and improving memory.

Cognitive Therapy addressing self-esteem, well-being, and any co-occurring symptoms of anxiety or depression.

Group Therapy , social support, strategies and skills training with others, and techniques for self-care.

Home-Life Strategies , mindfulness, relaxation techniques for reducing stress and anxiety.

Workplace Strategies , employer accommodations and career choices

Couples Therapy educating couples together about ADHD and its impact on relationships, finances, and family life.

ADHD Coaching An ADHD coach is professionally trained to guide and support a person in overcoming the challenges of living with ADHD and its impact at work, at school, and at home. Specifically, ADHD coaches help their clients: Set and reach individual goals (school, work) Provide structure needed for day to day tasks Emphasize the use of tools to stay on track Improve organizing skills & design organizing systems Plan projects, prioritize tasks, manage time effectively Increase self-awareness Renovate lifestyle habits such as diet, sleep, and exercise

An ADHD coach is professionally trained to guide and support a person in overcoming the challenges of living with ADHD and its impact at work, at school, and at home.

Specifically, ADHD coaches help their clients:

Set and reach individual goals (school, work)

Provide structure needed for day to day tasks

Emphasize the use of tools to stay on track

Improve organizing skills & design organizing systems

Plan projects, prioritize tasks, manage time effectively

Increase self-awareness

Renovate lifestyle habits such as diet, sleep, and exercise

Medication Option Our comprehensive evaluation takes out the guessing component and allows for a more specialized psychopharmacological intervention. Expertise in attentional disorders allows for careful selection of the most appropriate medications to get the benefits and avoid side effects. First rule of thumb: Do no harm Close monitoring by our team of professionals

Our comprehensive evaluation takes out the guessing component and allows for a more specialized psychopharmacological intervention.

Expertise in attentional disorders allows for careful selection of the most appropriate medications to get

the benefits and avoid side effects.

First rule of thumb: Do no harm

Close monitoring by our team of professionals

ADHD Medications Stimulants Ritalin, Ritalin SR, Ritalin LA Metadate ER, Metadate CD Concerta, Focalin IR, Focalin XR Adderall XR, Adderall XR, Dextrostat, Dexedrine span Cylert Non-Stimulants Strattera Wellbutrin SR, Wellbutrin XL Clonidine, Tenex TCA’s

Stimulants

Ritalin, Ritalin SR, Ritalin LA Metadate ER, Metadate CD Concerta, Focalin IR, Focalin XR

Adderall XR, Adderall XR, Dextrostat, Dexedrine span

Cylert

Non-Stimulants

Strattera

Wellbutrin SR, Wellbutrin XL

Clonidine, Tenex

TCA’s

Stimulants Diet and Nutrition Brain Neurotransmitters Dopamine Norepinephrine

Diet and Nutrition

Diet & Nutrition What we eat determines how effectively our brain operates Food affects metabolism and brain chemistry Poor diet alone can lead to distractibility, impulsivity and restlessness and look like ADHD when it is not Why it is important to eat breakfast?

What we eat determines how effectively our brain operates

Food affects metabolism and brain chemistry

Poor diet alone can lead to distractibility, impulsivity and restlessness and look like ADHD when it is not

Why it is important to eat breakfast?

The Role of Carbohydrates General Dietary Guidelines: Increased sugar consumption does not cause ADHD but can exacerbate symptoms of ADHD Eat lower Glycemic Index foods Increase protein, decrease carbs in your diet Reduces insulin, cortisol, improves concentration

General Dietary Guidelines:

Increased sugar consumption does not cause ADHD but can exacerbate symptoms of ADHD

Eat lower Glycemic Index foods

Increase protein, decrease carbs in your diet

Reduces insulin, cortisol, improves concentration

Nutritional Supplements Studies have shown altered Fatty Acid metabolism in ADHD! Consider Nutritional Supplements: Assist in managing ADHD To support traditional approaches to medical care Omega-3 Fatty Acids (DHA, EPA) Depression, Bipolar, ADHD benefits

Studies have shown altered Fatty Acid

metabolism in ADHD!

Consider Nutritional Supplements:

Assist in managing ADHD

To support traditional approaches to medical care

Omega-3 Fatty Acids (DHA, EPA)

Depression, Bipolar, ADHD benefits

Exercise: Schedule 30 Min. Daily Exercise promotes general health as well as mental focus. It’s a natural stimulant and antidepressant! Builds mental endurance and reduces mental fatigue. Excellent treatment for an ADHD emergency : A quick burst of exercise is like pushing the reset button on your brain. Children with ADHD should not miss recess or be denied sports as discipline.

Exercise promotes general health as well as mental focus. It’s a natural stimulant and antidepressant!

Builds mental endurance and reduces mental fatigue.

Excellent treatment for an ADHD emergency : A quick burst of exercise is like pushing the reset button on your brain.

Children with ADHD should not miss recess or be denied sports as discipline.

Positive Traits with ADHD Lots of energy Entrepreneurial: thinking “outside of the box” Charismatic, fun to be with Spontaneous Adventurous Sense of humor Creative Eager to help others Compassionate

Lots of energy

Entrepreneurial: thinking “outside of the box”

Charismatic, fun to be with

Spontaneous

Adventurous

Sense of humor

Creative

Eager to help others

Compassionate

How are we different? A team of experts – all together Many choices and options available Individualized Treatment Plan Clinicians who talk to each other Clinicians who listen to you

A team of experts – all together

Many choices and options available

Individualized Treatment Plan

Clinicians who talk to each other

Clinicians who listen to you