1. question  Do you have a parent organization?

2. WHO IS GUILTY?  This is what you may hear from your close environment:  The child is healthy – nevertheless there are problems, how is that?  When the child is involved in an accident – (for instance has taken(read: drinking) toxins) you are guilty  You do not provide structure the child needs

3. Research of Russ Barkley and Cunningham  OBSERVATIONAL STUDIES INDICATE THAT MOTHERS ARE ACTING IN A NEGATIVE WAY TOWARDS THEIR CHILD WITH ADHD: THEY ARE COMMANDING, VOICE MUCH CRITICISM  WHAT IS THE DIRECTION?

4. MOTHER - CHILD  TEST: THE DUO HAD TO RESOLVE PROBLEMS – THEY HAD TO WORK AS A TEAM  WHEN CHILD WAS ON MEDICATION (METHYLPHENIDATE) THE MOTHER WAS ACTING LESS NEGATIVE

5. CONCLUSION

6. CONCLUSION  NEGATIVE BEHAVIOR EMANATES FROM THE ADHD CHILD 

7. STROES ALBERTS AND VAN DER MEERE. JAACP (2004)  CHILD WITH ADHD – STUDENT  SPONTANEOUS BEHAVIOR OF THE STUDENT  CHILD TRIGGERED STRUCTURE PROVIDING BEHAVIOR IN THE STUDENT IN LESS THAN A MINUTE

8. WHAT MAKES THE CHILD WITH ADHD SO VULNERABLE?  1) HE/SHE LOOKS HEALTHY  2) PERFORMANCE FLUCTUATES  3) HE CAN WHEN HE WANTS

9. DEFINITION OF ADHD  FLUCTUATIONS IN STATE IS CHILD’S TRAIT  READING – BRAIN  CLUMSINESS – BRAIN  MOTIVATION – BRAIN (GUILTY?)

10. COMORBIDITY  Motivation versus cognitive deficit  ADHD – Oppositional Defiant Disorder  Conduct Disorder  - Learning disabilities

11. extra effort no extra effort optimal state non-optimal state Performance  Actual state vs. required (target) state – effort allocation Theory of state regulation Van der Meere (2005) In Gozal & Molfese ADHD: from genes to patients Totowa NJ Humana press)

12. Signal rate

13. Controls > ADHD: Fast Go Correct ADHD > Controls: Fast Go Correct Controls > ADHD: Slow Go CorrectADHD > Controls: Slow Go Correct

14. Controls > ADHD: Slow NoGo Correct ADHD > Controls: Slow NoGo Correct

15.   NRT is a neural sheet draped over the lateral/anterior aspects of the thalamus   NRT is the functional interface between the arousal and attention systems   Receives axonal collaterals from corticothalamic, thalamocortical and reticular formation projections Nucleus Reticularis Thalami Portas et al. 1998, J. of Neuroscience, 18

16. Stress response defined in terms of occurrence of facial movements Lips Part Jaw drop Lip Pressor Lip Suck

17. Van der Meere, Börger, & Wiersema (submitted) Mean frequency facial movements jjjjj jjjjj jj group Time on task

18. conclusion  ADHD associated with poor state regulation (underactivation) : in common parlance “poor motivation.  More research needed on factors that regulate energy metabolism in ADHD

19. IN THE MEANTIME  RESEARCH INDICATED THAT THE SEVERITY OF THE ADHD SYMPTOMS IS RELATED TO STRESS EXPERIENCED BY PARENTS  See: Anastopoulos et al (1992). Parenting stress among families of children with ADHD. Journal of Abnormal Child Psychology, 20, 503- 520.

20. Stress in families  Symptom Checklist 90-Revised (Derogatis, 1983). Manual for the SCL-90. Baltimore, MD.  90 items 5 point scale  Depression and somatic complains

21. Reduce stress  Family therapy/ parent training – it leads to an increase in parenting self-esteem and reductions in overall stress  Behavioral management principles  Take breaks