Dr. Kritsonis is Tenured Professor of Educational Leadership at Prairie View A&M University – Member of the Texas A&M University System. He teaches in the PhD Program in Educational Leadership. Dr. Kritsonis taught the Inaugural class session in the doctoral program at the start of the fall 2004 academic year. In October 2006, Dr. Kritsonis chaired and graduated the first doctoral student to earn a PhD in Educational Leadership at Prairie View A&M University. Since then, Dr. Kritsonis has chaired 22 doctoral dissertations along with serving as a committee member on many others.
A 2015 presentation by Victoria Costello, science journalist, author and mental health advocate, demonstrating how lay advocates can access and incorporate scientific evidence into their family and community advocacy for mental health for all. References Victoria Costello's memoir, A Lethal Inheritance, A Mother Uncovers the Science Behind Three Generations of Mental Illness, published by Prometheus in 2012. Presented on May 29, 2015 at the annual meeting of Parent Professional Advocacy League in MA. Website: http://www.mentalhealthmomblog.com
Attachment Studies With Borderline PatientsDemona Demona
Clinical theorists have suggested that disturbed attachments are central to borderline personality
disorder (BPD) psychopathology. This article reviews 13 empirical studies that examine the types
of attachment found in individuals with this disorder or with dimensional characteristics of BPD.
Comparison among the 13 studies is handicapped by the variety of measures and attachment types
that these studies have employed. Nevertheless, every study concludes that there is a strong associa-
tion between BPD and insecure attachment. The types of attachment found to be most characteristic
of BPD subjects are unresolved, preoccupied, and fearful. In each of these attachment types, indi-
viduals demonstrate a longing for intimacy and—at the same time—concern about dependency and
rejection. The high prevalence and severity of insecure attachments found in these adult samples sup-
port the central role of disturbed interpersonal relationships in clinical theories of BPD. This review
concludes that these types of insecure attachment may represent phenotypic markers of vulnerability
to BPD, suggesting several directions for future research.
Power point upload for class TECA 1311 about early childhood pioneer Bruce Perry, MD, Ph.D. Made by Jack DisPennett. Plagiarism is wrong and is just plain rude, so please do not copy without giving proper credit. Enjoy!
Anxiety Disorders in Kids...An Overview for Parents and TeachersStephen Grcevich, MD
This presentation is an overview of how anxiety symptoms manifest in children and teens, and an overview of the two primary treatment modalities (Cognitive-Behavioral therapy and medication). This talk was presented with Dr. Sherri McClurg at Lake Ridge Academy in North Ridgeville, OH, October 6, 2011.
In this presentation, Dr. Steve Grcevich will...
Explore the rationale for regular consideration of deprescribing in children, teens and adults with mental health conditions.
Examine the indications for deprescribing in individual patients.
Consider a process for simplifying complex medication regimens in patients with suboptimal therapeutic benefits and/or unacceptable adverse effects.
This chapter is from Drugging Our Children (Olfman & Robbins, 2012), a great book about the epidemic prescription of antipsychotics to children, especially poor children and children of color.
Evaluation and Treatment of Bipolar and Related Disorders in Children and Ado...Stephen Grcevich, MD
In these lectures presented by Dr. Stephen Grcevich to child and adolescent psychiatry trainees at Akron Children's Hospital in January 2021, the following objectives were addressed:
Identify critical questions challenging our assumptions regarding treatment of bipolar disorder in kids.
Explore diagnostic challenges associated with comorbidity with other common mental health conditions.
Review key literature evaluating effective pharmacotherapy of pediatric bipolar disorder.
Examine available data on non-pharmacologic treatments in kids with bipolar disorder.
The Role of Mental Health Professionals in Adoption Ashutosh Ratnam
A seminar presentation I made on the role mental health professionals are expected and required to play in adoption. The presentation was made for an Indian setting, covering briefly the Hindu Adoption Act and the Guardianship Act, but the major of the presentation is on
why adoptees tend to have higher percentages of psychiatric problems, what adoption competent mental healthcare entails, and special emphasis on the process of disclosure to the child.
A 2015 presentation by Victoria Costello, science journalist, author and mental health advocate, demonstrating how lay advocates can access and incorporate scientific evidence into their family and community advocacy for mental health for all. References Victoria Costello's memoir, A Lethal Inheritance, A Mother Uncovers the Science Behind Three Generations of Mental Illness, published by Prometheus in 2012. Presented on May 29, 2015 at the annual meeting of Parent Professional Advocacy League in MA. Website: http://www.mentalhealthmomblog.com
Attachment Studies With Borderline PatientsDemona Demona
Clinical theorists have suggested that disturbed attachments are central to borderline personality
disorder (BPD) psychopathology. This article reviews 13 empirical studies that examine the types
of attachment found in individuals with this disorder or with dimensional characteristics of BPD.
Comparison among the 13 studies is handicapped by the variety of measures and attachment types
that these studies have employed. Nevertheless, every study concludes that there is a strong associa-
tion between BPD and insecure attachment. The types of attachment found to be most characteristic
of BPD subjects are unresolved, preoccupied, and fearful. In each of these attachment types, indi-
viduals demonstrate a longing for intimacy and—at the same time—concern about dependency and
rejection. The high prevalence and severity of insecure attachments found in these adult samples sup-
port the central role of disturbed interpersonal relationships in clinical theories of BPD. This review
concludes that these types of insecure attachment may represent phenotypic markers of vulnerability
to BPD, suggesting several directions for future research.
Power point upload for class TECA 1311 about early childhood pioneer Bruce Perry, MD, Ph.D. Made by Jack DisPennett. Plagiarism is wrong and is just plain rude, so please do not copy without giving proper credit. Enjoy!
Anxiety Disorders in Kids...An Overview for Parents and TeachersStephen Grcevich, MD
This presentation is an overview of how anxiety symptoms manifest in children and teens, and an overview of the two primary treatment modalities (Cognitive-Behavioral therapy and medication). This talk was presented with Dr. Sherri McClurg at Lake Ridge Academy in North Ridgeville, OH, October 6, 2011.
In this presentation, Dr. Steve Grcevich will...
Explore the rationale for regular consideration of deprescribing in children, teens and adults with mental health conditions.
Examine the indications for deprescribing in individual patients.
Consider a process for simplifying complex medication regimens in patients with suboptimal therapeutic benefits and/or unacceptable adverse effects.
This chapter is from Drugging Our Children (Olfman & Robbins, 2012), a great book about the epidemic prescription of antipsychotics to children, especially poor children and children of color.
Evaluation and Treatment of Bipolar and Related Disorders in Children and Ado...Stephen Grcevich, MD
In these lectures presented by Dr. Stephen Grcevich to child and adolescent psychiatry trainees at Akron Children's Hospital in January 2021, the following objectives were addressed:
Identify critical questions challenging our assumptions regarding treatment of bipolar disorder in kids.
Explore diagnostic challenges associated with comorbidity with other common mental health conditions.
Review key literature evaluating effective pharmacotherapy of pediatric bipolar disorder.
Examine available data on non-pharmacologic treatments in kids with bipolar disorder.
The Role of Mental Health Professionals in Adoption Ashutosh Ratnam
A seminar presentation I made on the role mental health professionals are expected and required to play in adoption. The presentation was made for an Indian setting, covering briefly the Hindu Adoption Act and the Guardianship Act, but the major of the presentation is on
why adoptees tend to have higher percentages of psychiatric problems, what adoption competent mental healthcare entails, and special emphasis on the process of disclosure to the child.
Dr. Karen Weddle-West & Dr. Rosie Phillips Bingham, University of MemphisWilliam Kritsonis
Dr. Karen Weddle-West & Dr. Rosie Phillips Bingham, University of Memphis - Published by NATIONAL FORUM JOURNALS, Dr. William Allan Kritsonis, Editor-in-Chief, www.nationalforum.com
Dr. Fred C. Lunenburg - 1]. schools as open systems schooling v1 n1 2010William Kritsonis
Dr. Fred C. Lunenburg, featured author, published in NATIONAL FORUM JOURNALS, Houston, Texas, www.nationalforum.com
Dr. William Allan Kritsonis, Editor-in-Chief, NATIONAL FORUM JOURNALS
Dr. Clement Glenn, Featured Author, NATIONAL FORUM JOURNALSWilliam Kritsonis
Dr. Clement Glenn, Featured Author, NATIONAL FORUM JOURNALS
www.nationalforum.com. NATIONAL FORUM JOURNALS, Founded in 1983 - over 5,000 professors published. Dr. William Allan Kritsonis, Editor-in-Chief, NATIONAL FORUM JOURNALS, Houston, TEXAS
A MIXED-METHOD ANALYSIS OF THE IMPACT OF HIGH STAKES TESTING ON ENGLISH LANGU...William Kritsonis
A MIXED-METHOD ANALYSIS OF THE IMPACT OF HIGH STAKES TESTING ON ENGLISH LANGUAGE LEARNERS IN MAJOR URBAN HIGH SCHOOLS IN TEXAS by Arhtur L. Petterway, PhD
PhD Committee Members - Dr. M. Paul Mehta, Dissertation Chair; Committee Members: Dr. William Allan Kritsonis, Dr. Douglas S. Hermond, Dr. David E. Herrington, Dr. Camille Gibson
EMOTIONAL REGULATION AND COGNITIVE FLEXIBILITY AS PREDICTORS OF MATERNAL ACCE...indexPub
Raising a child with autism poses distinct challenges for parents. Maternal acceptance of the diagnosis and associated behaviors promotes positive family adaptation. This study aimed to examine emotional regulation and cognitive flexibility as intrapsychic predictors of maternal acceptance among Saudi mothers of autistic children. A sample of 50 mothers completed self-report measures of emotional regulation, cognitive flexibility, and acceptance. Correlation analysis found significant positive associations between emotional regulation, cognitive flexibility, and acceptance. Regression analysis indicated both emotional regulation and cognitive flexibility as significant positive predictors of maternal acceptance, with emotional regulation evidencing a stronger relationship. These results empirically validate theorized links between coping capacities and acceptance that have previously been established primarily through qualitative research. Findings also extend the predominantly Western literature by demonstrating relevance within a novel Saudi cultural context. This research provides guidance for designing psychosocial interventions to assist families managing autism globally. Targeting parental emotional regulation and flexible thinking may improve acceptance and adaptation across cultures.
Research-Based Interventions: Dissociative Identity Disorder 1
THIS IS AN EXAMPLE PLEASE DO NO COPY DO NOT PLAGiarism
Research-Based Interventions: Dissociative Identity Disorder
“Dissociative identity disorder is characterized by the presence of two or more identities or personality states, each with its relatively enduring pattern of perceiving, relating to, and thinking about the environment and the self” (Vermetten, Schmahl, Lindner, Loewenstein, & Bremner, 2006). There are many characteristics used that accompany Dissociative Disorder (DID). One method to understanding would be to know how the disorders are classified and defined. DID may be conceptualized effectively using the diathesis-stress model. There are many different intervention strategies for this disorder as well. Over time researchers have discovered the most effective treatments and interventions that can be used regarding DID. When one dissociates, the person may not have conscious awareness of what is happening (Vermetten, Schmahl, Lindner, Loewenstein, & Bremner, 2006).
Peer-reviewed Articles
One limitless, longitudinal, naturalistic, and prospective study investigated childhood maltreatment (CM) in adult intimate partner violence (IPV) victims among Dissociative Disorder (DD) patients with Dissociative Identity Disorder with CM rates of 80-95% and severe dissociative symptoms (Webermann, Brand, & Chasson, 2014). The methods of this study include 275 DD outpatient therapy patients who completed a self-reported measure of dissociation (Webermann, Brand, & Chasson, 2014). Analyses assessed associations between CM typologies, trait dissociation, and IPV (Webermann, Brand, & Chasson, 2014). The results of this study include emotional and physical child abuse associated with childhood witnessing of domestic violence, physical, and emotional IPV (Webermann, Brand, & Chasson, 2014) Two-tailed independent samples t -tests and z-tests were used in this study to represent data as well. “As an effect size, odds ratios (ORs) were calculated to predict the likelihood of a participant being in an abusive adult relationship if they experienced a particular type of CM” (Webermann, Brand, & Chasson, 2014, p. 5).
A double-blind study was conducted including 15 females with DID compared to 23 without psychopathology., chosen by self-disclosure results of a questionnaire along with a structured clinical interview by psychiatrists The objective was to examine the volumetric differences between amygdala and hippocampal volumes in patients with dissociative identity disorder, a disorder that has been associated with a history of severe childhood trauma (Vermetten, Schmahl, Lindner, Loewenstein, & Bremner, 2006). These researchers used MRI to measure volumes of the amygdala and hippocampus. The results included the volume of the hippocampus being 19.2 % smaller and the amygdala being 31.6% smaller in patients with DID when compared to the other subjects without psychopath ...
This program is part of a comprehensive School Mental Health and High School Curriculum Guide.
Find out more about the guide by visiting:
teenmentalhealth.org
Proof version: Bishop, D., & Rutter, M. (2008). Neurodevelopmental disorders: conceptual approaches. In M. Rutter, D. Bishop, D. Pine, S. Scott, J. Stevenson, E. Taylor & A. Thapar (Eds.), Rutter's Child and Adolescent Psychiatry (pp. 32-41). Oxford: Blackwell.
Genetics of attention deficit hyperactivity disorder (adhd)Joy Maria Mitchell
Attention deficit hyperactivity disorder (ADHD) is a developmental disorder. ADHD is the commonly studied and
diagnosed as psychiatric disorder. Here we shall see the relation between extraversion and ADHD, neuroticism,
biological relation, Environmental factors and with diagnosis of ADHD. It is known that Genetics is one of the factors
that may contribute to, or exacerbate ADHD. Recent research probing towards the environmental and Genetic factors
causing ADHD differences is the main source for investigation
Similar to Horn, Deborah e[1]. neurological differences between adhd and childhood bipolar disorder (15)
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Horn, Deborah e[1]. neurological differences between adhd and childhood bipolar disorder
1. NATIONAL FORUM SPECIAL EDUCATION JOURNAL
VOLUME 19, NUMBER 1, 2008
Neurological Differences between Attention Deficit
Hyperactivity Disorder and Childhood Bipolar
Disorder
Deborah E. Horn, MS Karen Osterholm, PhD, LPC, LPCS
Instructor – Psychology Assistant Professor
Social Science Division Department of Educational Leadership and Counseling
Blinn College The Whitlowe R. Green College of Education
Brenham, Texas Prairie View A&M University
Doctoral Candidate in Clinical Psychology Member of the Texas A&M University System
Argosy University – Dallas
Dallas, Texas
Mary Alice Kritsonis, EdD
Online Editor
National Research and Manuscript Preparation Editor
National FORUM Journals
Houston, Texas
________________________________________________________________________
ABSTRACT
The difficulty of differentially diagnosing attention deficit/hyperactivity disorder
(ADHD) and childhood bipolar disorder is discussed from the standpoint of
neurological assessment and abnormalities. Research has not addressed this
problem. However, studies on each individual disorder are examined. Use of tools
such as EEGs, MRIs, fMRIs, and SPECT are discussed.
________________________________________________________________________
Introduction
Diagnosis of childhood disorders is an intricate and challenging process. One
reason is many disorders have symptoms overlapping to a significant degree those
characterizing other disorders. For example, attention deficit/hyperactivity disorder
(ADHD) has many of the same symptoms as childhood bipolar disorder (Fewell &
1
2. NATIONAL FORUM SPECIAL EDUCATION JOURNAL
2_____________________________________________________________________________________
Deutscher, 2002). Misdiagnosing ADHD when the child is actually suffering from
childhood bipolar disorder can result. The diagnosis of ADHD would suggest treatment
with a stimulant such as Ritalin, Dexedrine, or Benzedrine. However, the administration
of such a drug might only serve to induce mania in the child with bipolar disorder.
Through the lens of the ADHD label, this increase in hyperactivity might even result in
increased dosages of the stimulant, thus exacerbating the mania further. Development of
an objective and precise method for accurate differentiation between these two disorders
is important. One promising direction may lie in the neurological differences between the
two maladies.
Purpose of the Article
The purpose of this article is to discuss differential diagnosing of attention
deficit/hyperactivity disorder (ADHD) and childhood bipolar disorder from the
standpoint of neurological assessment and abnormalities.
Symptoms
Before examining the neurological differences between ADHD and childhood
bipolar disorder, symptoms associated with each will be identified. ADHD involves five
categories of symptoms that the client must match before diagnosis, according to the
DSM-IV-TR (APA, 2000). The first category consists of two groups. The first group is
associated with inattention that has been evident for a minimum of six months and
interferes with the individual’s functioning. Examples include losing objects, failing to
finish projects or tasks, inability to stay on task, and inability to listen to others. The
second group consists of hyperactivity-impulsivity behaviors that interfere with overall
functioning. Examples are inability to remain still, difficulty remaining seated, problems
with turn taking, and interrupting frequently. Symptoms must have manifested before the
age of seven. The disorder must be demonstrated in two different locations, e.g. school
and home. “There must be clear evidence of clinically significant impairment in social,
academic, or occupational functioning” (p. 93). Lastly, diagnosis requires that the
symptoms not appear associated with other difficulties such as mood, anxiety, or
dissociative disorders.
Many children with ADHD may also present with symptoms derived from their
experiences as sufferers of the disorder. For example, it is not unusual for ADHD
children to have a history of accidents such as broken bones, falls, and other accidents.
Impulsivity may render the child inattentive to safety measures. The child might also
suffer from low self-esteem and subsequent depression related to having been teased and
experiencing other difficulties with social interactions.
3. DEBORAH E. HORN, KAREN OSTERHOLM, AND MARY ALICE KRITSONIS
_____________________________________________________________________________________3
Bipolar disorder is somewhat difficult to diagnose in children simply because this
problem is seen more often in the adult population. In fact, the DSM-IV-TR (APA, 2000)
reports that bipolar conditions are often first seen during the twenties rather than earlier in
life. Various types and levels of bipolar disorder have been described. Basically,
however, the disorder involves periods of mania and depression occurring sequentially or
simultaneously. Symptoms of depression in children might include irritable mood,
crying, anhedonia, less than expected weight gain for growing children, sleep difficulties,
psychomotor agitation, low self-esteem, feelings of guilt, deficits in thinking, and
possibly thoughts of suicide. Symptoms of mania for children include high self-esteem,
finding sleep unnecessary, talkative periods, racing thoughts, and distractibility.
When comparing these symptoms to those of ADHD, considerable overlap is
evident. Consequently, children presenting with such symptoms are more likely
diagnosed with the disorder considered the most common in children – ADHD. However,
crying, anhedonia, failure to make developmentally appropriate weight gains, suicidal
thoughts, and high self-esteem do not seem to be associated with ADHD. Thus, further
evaluation is warranted when children present with the latter set of characteristics as well
as ADHD symptoms.
In summary, it appears that the child with ADHD may present with greater
attention problems than the child who has bipolar disorder. The child with bipolar may
demonstrate greater or more intense emotional reactions or difficulties. However, this
dichotomy is not a perfect one and would not necessarily be sufficient for differential
diagnosis of these two disorders. In extreme examples of both maladies, differentiation
might be more readily accomplished. In the majority of cases, which involve more
moderate symptoms, the distinction is more difficult.
Etiology
When etiology is explored as a possible differentiation tool, the most prominent
theory involves genetics (Fletcher-Janzen & Reynolds, 2003). Since both disorders seem
to have familial associations, examination of family histories may aid differential
diagnosis. Children with ADHD and those with bipolar disorder are more likely to have
relatives with “matching” diagnoses. However, effectiveness of this tool may be limited
because relatives might have been misdiagnosed as well.
Accurate diagnosis is critical. “Among adolescents diagnosed with BAD [Bipolar
Affective Disorder], around 20% make serious suicide attempts” (Fletcher-Janzen &
Reynolds, 2003, p. 87). Additionally, both the bipolar and the ADHD adolescent are
likely to engage in criminal behaviors if they are untreated. Manic states and impulsive
behaviors increase risk- taking and consequent injury or arrest.
Some theories regarding the etiology of ADHD suggest that this disorder results
from minimal brain damage. “Brain damage as a result of infection, trauma, and
complications during pregnancy or at the time of delivery has been postulated as potential
causes [sic] of ADHD; however, routine neurological examination of children with
4. NATIONAL FORUM SPECIAL EDUCATION JOURNAL
4_____________________________________________________________________________________
ADHD is generally normal” (Fletcher-Janzen & Reynolds, 2003, p. 74).
Masi and associates (2003) determined that many children and adolescents
diagnosed with ADHD are subsequently diagnosed with bipolar disorder. They suggest
that the two difficulties are comorbid but do not consider the possibility that ADHD is a
misdiagnosis of bipolar disorder that has not yet completely manifested itself. In other
words, the early stages of bipolar disorder may be erroneously identified as ADHD.
Neurological Deficits Associated with ADHD
Brain damage is not always detectable through analysis of scans or wave
recordings, but such damage may be assumed on the basis on neurological test results.
For example, Temple and Sanfilippo (2003) believe that ADHD is associated with
impairments in the executive functions, which might develop from frontal lobe damage.
Many ADHD children have a history of injuries such as broken bones. Perhaps their first
injury involved frontal closed-head trauma, resulting in increased injury-proneness and
deficits in areas of attention. Unfortunately, a child who has bipolar disorder might also
exhibit attention deficiencies, especially when she or he experiences depression with
associated concentration difficulties.
Support for the hypothesis that ADHD results from brain injury is found in the
fact that many ADHD children have seizure disorders, which can also originate from
brain trauma (Schubert, 2005). This relationship may render it difficult to determine
whether an individual’s ADHD behavior is due to inattention or subclinical seizures, an
important distinction given the differential treatment indicated for these two
circumstances. The question can be resolved through the use of EEGs because this
method can distinguish whether an individual is experiencing a particular type of seizure
or is simply not attending. The EEG will also provide evidence of the frequency of
subclinical spiking, which may affect the ability to attend as well as other cognitive
functions. Consequently, EEGs may lead to relatively simple ways of diagnosing ADHD.
Interestingly, some experts believe that ADHD treatment can be enhanced due to
the plasticity of the brain (Ito, 2004). In other words, the child’s brain could be retrained
so that she or he could focus and sustain attention within the normal range of functioning.
Training in attention maintenance, particularly utilizing treatment protocols involving
CBT methods, seems helpful in alleviating some problems for ADHD children.
In an attempt to use brain scans to predict development of ADHD, Wang and Kuo
(2003) used gray-scale transfrontal sonography to detect abnormalities in the arteries
supplying blood to the basal ganglia. Vasculopathy was detected in infants who later
developed ADHD, tics, or obsessive-compulsive behaviors. Whether these abnormalities
can be detected beyond infancy has not been established.
Sowell and associates (2003) were able to find peculiarities in the brains of
individuals with ADHD by using high resolution MRIs. The findings of their research
indicated:
5. DEBORAH E. HORN, KAREN OSTERHOLM, AND MARY ALICE KRITSONIS
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Abnormal morphology was noted in the frontal cortices of patients
with attention-deficit hyperactivity disorder, with reduced regional
brain size localized mainly to inferior portions of dorsal prefrontal
cortices bilaterally. Brain size was also reduced in anterior temporal
cortices bilaterally. Prominent increases in grey matter were
recorded in large portions of the posterior temporal and inferior
parietal cortices bilaterally. (p. 1699)
These researchers’ interpretation of results is that all lobes (with the exception of
the occipital) are association cortices of the hetermodal type comprising a complex
system throughout the nervous system. This becomes the basis of inhibitory responses
and attention. Such “identified region-specific anatomical abnormalities in cortical
components of attentional systems … may help better account for the symptoms of
attention-deficit hyperactivity disorder” (p. 1699).
Use of the Single Photon Emission Computed Tomography (SPECT) also appears
helpful in determining whether an individual has ADHD (Vles, Feron, Hendriksen,
Jolles, van Kroonenburgh, & Weber, 2003). Vles and associates used SPECT to examine
the brain dopamine transporter and receptor activity, finding that abnormalities were
present prior to the use of stimulants. After stimulant treatment began, they found a
down-regulation of the transporter system of dopamine. Consequently, an examination of
the brain dopamine system might be one diagnostic method for ADHD.
Thus, it would seem diagnosis of ADHD might be supported by certain
neurological assessments. The first would involve neurological examinations that directly
assess attention. However, childhood attention tests that could differentiate between
ADHD and attention problems resulting from mood disorders would be ideal. A
neurological examination that consists of EEGs that would detect seizure activity would
also be important, since subclinical seizure activity might underlie ADHD. Additional
use of MRIs and SPECTs would also assist in the diagnosis of ADHD. These
assessments might aid the clinician in ruling out bipolar disorder. However, it is crucial
that further research be conducted with specific reference to these two disorders in order
to establish valid protocols of assessment.
Neurological Deficits Associated with Childhood Bipolar Disorder
Very little research has been conducted with children diagnosed with pediatric
bipolar disorder, especially with regard to neurological deficits. Hence, the majority if not
all of the research presented is based on adult subjects unless otherwise stated.
Considerable investigation is needed with adequate data analysis related to the
neurological deficits and difficulties of this particular population. Whether or not research
on adults can be extrapolated to children has not been determined.
Frey and associates (2005) studied neurometabolites in the dorsolateral prefrontal
cortex. They found that the phosphoinositide-signaling pathway was not operating
6. NATIONAL FORUM SPECIAL EDUCATION JOURNAL
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normally for individuals in the manic phase of bipolar disorder. The researchers noted
that further investigation with regard to manic and depressive states is necessary to
determine how this abnormality impacts the bipolar individual.
Ahn and other researchers (2004) note abnormal differences between white matter
in individuals without bipolar disorder and those with bipolar disorder. By taking slices
of magnetic resonance images of white matter, the researchers were able to examine them
for prevalence and severity of hyperintensities. Individuals with bipolar had an abnormal
number of white matter hyperintensities. Other researchers have found similar results in
studies that investigated white matter hyperintensities in bipolar patients. Craven, James,
and Murphey (2002) noted that when individuals have cerebral palsy, the probability is
high that bipolar disorder is present as well. They report finding an association with white
matter lesions in these two disorders in adolescents. However, it should be noted that
others believe that white matter hyperintensities might be due to treatment with lithium
(Breeze, Hesdorffer, Hong, Frazier, & Reshaw, 2003). Thus, the medication generally
considered the treatment of choice might produce abnormalities within the brain, and
these abnormalities could be misinterpreted as resulting from the disorder itself.
One of the primary difficulties in studying bipolar disorder is that there are
different types of bipolar, such as bipolar I and bipolar II. McGrath and associates (2004)
reviewed the literature regarding comparisons of neurobiological differences between the
two types and found that few studies examined this difference. Those in evidence yielded
inconclusive results. The authors noted that research on genetic differences implied
dissimilarities between the two types.
The functional MRI is recognized as the most useful tool for detecting
abnormalities in the brain structure of individuals with bipolar disorder (Malhi,
Lagopoulos, Owen, & Yatham, 2004). Malhi and associates drew this conclusion after
reviewing the literature related to analysis of neurological abnormalities in bipolar
patients. They noted that the majority of studies reporting differences used the fMRI.
Specifically, they suggest, “the patterns of fMRI activation are different to those found in
healthy subjects and patients with major depression. FMRI studies are likely to provide
valuable insights into the pathophysiology of bipolar disorder” (p. 46).
In summary, it does appear that neurological differences provide indicators that
bipolar disorder is present. Whether or not these differences are present in children is
unknown. It would seem that the fMRI is the most widely used assessment tool in
investigating bipolar disorder. Using fMRI in examining children with bipolar disorder
would be an important step toward understanding the neurological differences such
children exhibit.
Concluding Remarks
Assessment of the limbic system is one area of neurological investigation with
great promise for differentiation between children with ADHD and children with bipolar
disorder. Malhi, Lagopoulos, Ward, Kumari, Mitchell, Parker, Ivanovski, and Sachdev
7. DEBORAH E. HORN, KAREN OSTERHOLM, AND MARY ALICE KRITSONIS
_____________________________________________________________________________________7
(2004) report that fMRIs successfully differentiated between bipolar and normal
individuals who were presented with positive and negative captioned pictures. They
“conclude that bipolar depressed patients perhaps recruit additional subcortical limbic
systems for emotional evaluation and this may reflect state-related or trait-related
dysfunction. The differential patterns of activation inform us about bipolar depression
and have potential diagnostic and therapeutic significance” (p. 741).
One difficulty in comparing neurological research conducted with ADHD
subjects and with bipolar subjects is that different tools are likely to be used in assessing
the two disorders. Functional MRIs are typically utilized when the research involves
bipolar individuals. ADHD individuals are typically investigated with EEGs, MRIs, and
SPECT. This makes it difficult to make comparisons between the two disorders in terms
of abnormalities. It does seem that both difficulties involve the prefrontal lobe of the
cortex. The limbic system is also involved in the neurological pathology of the bipolar
patient, but it does not appear to be an aspect of ADHD. Thus, this area is most likely to
generate the best differential diagnosis in adults when ADHD must be ruled out. Whether
it is effective with children has not been explored. Little is known about limbic system
development in the maturing child. Thus, identification of abnormalities in the immature
limbic system might not allow the degree of specificity needed for diagnostic purposes,
especially for ruling out a specific disorder.
Diagnosing children accurately and with specificity is especially important given
their position on the developmental timeline. In other words, failure to keep a child on the
“road” to normal development might have a long-term impact on her or his life as an
adult. For example, children with untreated ADHD might develop academic problems
that eventually lead to dropping out of school or development of conduct disorder.
Children with untreated bipolar disorder might ultimately become suicidal. Appropriate
treatment for correctly identified childhood disorders could assist the child in continuing
to develop normally. Thus, further research in this area is necessary before any
conclusions can be drawn regarding differential diagnosis of ADHD and bipolar children.
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