This is how you treat ADHD based off science, Dr Russell Barkley part of 2012 Burnett Lecture

so I want you to understand that you have a brain, the back

part

is where you learn, the front

part

is where you learn, perform, know, do, and ADHD divides them. I don't care what you know, you won't use it. you can be the brightest kid in the world it's not going to matter so you have a real problem on your hands because you may know things and you won't do things that are a serious problem called performance disorder so what we know about ADHD is that you will put all five levels at risk because it interferes with the seven executive functions and you will have time blindness and will not be able to orient your behavior towards the future to take care of yourself as effectively as other people. you are capable of doing you have an intention deficit disorder you have a performance disorder without knowledge you know what to do but you cannot do it you have a disorder of when and where not what and how your problem is not knowing what to do it is doing what You know.

What does that mean? It means that all interventions must be done in that place in the environment where you are not doing what you know to help you show what you know. I have to create a scaffold around it. you to help you do

this

, what does

this

mean for

treat

ment? Teaching skills are inadequate, it won't work, you can sit down with someone with ADHD and tell them what you need to do, good luck, right, they won't even leave your office, you act. as if they were stupid, they are not, they know what to do, they know what you are telling them to do right, they are not going to do it when they leave, that information has no control value over their lives and it works.

You start to interpret it as a motivational problem, but the only way to deal with executive deficits is to redesign the environment around them to help them demonstrate what they know and all the

treat

ments have to be available in their lives, where you have to. build that scaffolding that all of this in ADHD is due to neurogenetic deficits and that means that medication is absolutely justifiable after all, if you have a neurogenetic disorder, then neurogenetic therapies have a role to play in your disorder and they do, 80% of people with ADHD will. be taking medication at some point in your life and the good thing is that it is the most effective thing we have.

There are other things we can do, but that is the most effective. Now it's possible that you can train some of these executive functions, we don't know. We still don't know if practicing working memory really helped you in life; There is no evidence that it does so at this time, at least not convincingly, but there is a possibility, what we do know is that we should not make excuses for your mistakes because the problem is yours. What we're having has no consequences, so why would I excuse them? The problem they are having is with the delay in the consequence.

All important social consequences are delayed consequences and that is their problematic moment, so the solution to anyone's problem with an executive deficit is to toughen up. Increase responsibility to make you more accountable to other people with more artificial consequences than necessary, but I need to get the consequences to you in time, so I'm not going to excuse your behavior. Actually, I'm going to do it. I make you more responsible than other people and that is why we do bod bod allows me to spread artificial consequences throughout the environment to improve your functioning and that means that the success of my intervention is

based

on the will of other people in the natural environment. to make those changes if you are not willing to build ramps, so to speak, to build the scaffolding, it is not going to work, the stakeholders have to participate, it means that ADHD is the diabetes of psychiatry, it is a chronic disorder that must be be treated every day. to prevent the secondary damage it will cause, but there is no cure for this disorder now, approximately one in six people could overcome it, maybe even one, and three I'm not sure yet, but the vast majority, two thirds will still have ADHD . in adulthood and they need to see ADHD as diabetes of the brain, it's a chronic disorder, so here are the things my theory tells you to do to help people with executive deficits.

This is what I told you this morning. This is take-home money. the value of changing your framework from an attention disorder to an executive disorder and the theory tells you the six things you must do, the first step is to make mental information physical, you must externalize the information because working memory triggers , that means we have to use signs signs graphics reminders I have to put things in your field of vision to remind you what to do here and now make it external again the next thing I have to do is make time real physical through watches stopwatches counters watchmen anything I can enlist that will put time outside of you so that you can watch it go by and judge your performance in relation to it because you don't have a watch, we have to put one in your field of vision.

I'm going to have to take a long time. tasks because they involve time lapses and eliminate time, make them small installments, small steps to cross the bridge in time, a little work done frequently over time and it will get you there, but you will not do book reports, projects scientists and others. things on your own, you can't, they involve delays and you can't handle delays, so the best way to solve the problem is to get rid of the delay and bring it back to the now through Little Steps, divide all long-term projects in baby. steps, take one small step each day, you get there and if you don't do it, they aren't doing it, you have to make the motivation external, they can't create internal motivation, they depend on the environment for their motivation, you have to put the consequences in the Now or they won't work for you This is what video games do and what homework doesn't do, this is why they can play video games for hours and not do their homework for more than a few minutes.

Video games provide continuous external reinforcement. Homework doesn't do anything, video games don't need external or internal motivation, while homework does, so you have to create motivation, you're going to start having to make a deal with your children, what's in it for them, what are you putting them in, what are you doing? What are you creating? What is the reward? What are the points? What is the token? What is the sex? Drugs and money. Whatever it is, you'll have to negotiate a deal. There has to be a consequence or it won't be done. You have to make a troubleshooting manual.

Remember that they cannot do mental manipulations like other people. That's why they can't do the digit span backwards, but it has nothing to do with the digit span. They cannot keep things in mind and move them too. like other people, so don't force them to do it, put it in their hands if they have a math problem to solve, give them marbles, a number line and a Backus, a calculator, let them solve the problem manually or at least help solve the problem mental with manual parts, it's the principle that matters, people can come up with a lot of ideas here and then finally, and this is the most important thing, the executive system has a limited fuel tank and can use it up very quickly every time that an executive uses. it works and you use it continuously you empty the tank and if you reach the bottom of the tank in the next situation you will not have self control this is the ADHD kid after school is gone and you want to do the homework you don't have your mind so you have to refuel that tank and that tank has a very limited capacity so how do we refuel the tank?

Interesting, there are many things we have discovered to boost the tank using rewards and positive emotions using self-statements of Effectiveness I can do this I know I can do this this is the pep talk in the locker room before the game helps increase motivation In addition to that, you need to take 10 minute breaks very often, in fact more often you need to divide the pass into smaller units and take frequent breaks and during those breaks a little relaxation and meditation helps refuel the tank stop use the executive system for a few minutes and give it a chance to restore its fuel tank that's why we talk about the 10 and three rule with kids with ADHD 10 minutes of work three minutes of rest 10 and three 10 and three but you can't do over 10 you're starting to empty the tank give them a chance to refill the tank what does it say about keeping Kids In For?

Recess, when you don't finish all your homework, you've just shot yourself in the foot and that brings me to the next thing, visualizing and talking about future rewards will help you fuel up, as will the physical exercise routine, exercise aerobic increases tank. replenishes it and creates a larger tank. Everyone with ADHD should participate in an exercise program because research shows it benefits this disorder better than any other psychiatric disorder and now you know why it helps to refuel that tank and finally, the fuel in the tank is sugar. in the bloodstream in the frontal lobe blood glucose in the frontal lobe is directly correlated with executive abilities, what does that mean?

If you have a long task that involves your executive brain, like a test you have to take, you'd better be drinking some lemonade or a Gatorade or a sports drink by drinking, not swallowing, you'll need to maintain your blood sugar level. high to keep this fuel tank partially restored, so this is the opposite of what people once thought that sugar harms people with ADHD, no it doesn't. and I never did, but it may help you if it is in liquid form that can reach the brain very quickly. You have to keep your blood glucose high. Those are the things you can do to increase your fuel tank.

There are several approaches on the market for adults and college students with ADHD that incorporate these ideas. Steve or Russ Ramsey's program, which is cognitive behavioral therapy, does a good job. I'm not going to explain this with you. Steve Saffron's program is even better because it's

based

on this model of executive functioning, so Steve talks about what can be done to improve executive functioning in adults who are on medications but they have to be on medications and the most recent one came out on March, is the most executive in nature, is Mary Santo's program to train executive functioning in adults with ADHD these are the three proven programs that have been shown to improve the effects of medications in adults with ADHD and they all target those deficits in the executive brain as part of their models, so what have you learned today?

You learned that ADHD is not an attention disorder. You have learned that it is an executive disorder. That the executive system is a very complex multilevel system, like driving. There is one level of cognition and that's it. It is multilevel. It is complex and extends to our daily lives. You know that ADHD disrupts that system through behavioral innovation and eliminates all other executive abilities, putting you at risk for failure in your executive activities in your daily life. People with ADHD have problems in all dimensions of executive functioning. in their daily lives and that will lead them to have great difficulties getting along with other people, building friendship networks, cooperatives, subordinating their interests to others, everything that involves executive functioning, from money management to driving, friends, families, etc.

Others are at serious risk for this disorder because they all depend on this executive system, so we are going to have to help people with ADHD build the scaffolding around them and use medication like neurogenetic therapy with them to compensate for these. executive deficits that we have. We will have to design prosthetic environments around them. You know, the beauty of ADHD is that it is the most treatable disorder in psychiatry. There is no disorder that we treat that has as many medications and as many psychosocial treatments that are as effective as these. for the largest number of people that produce more changes than any other medication and psychosocial treatment for these people, do you know that 55% of people who take medications become normal? 90% of them answer do you know that the effects of ADHD medications are three times greater than those of anxiety medications? and antidepressants that you all give away like candy in your practice, here we have in our hands enormous and effective medications that we can use and we also have very effective psychosocial interventions.

This is the most treatable disorder we face. The biggest problem is most people. they do not receive treatment 40% of children and 90% of adults with ADHD are not recognized or treated for their disorder, that is the problem, it is not that we are overtreating, we are undertreating and we are undertreating the disorder more treatable in psychiatry, thank you, welcome. You're welcome, just in time. Can I close the fire hydrant? I know they won't leave anymore. I can not stand it. There is too much information. Luckily, this will be on the Internet, so you should go back and check it out. and you also have yourhandouts, so we are going to proceed with the questions now that we have collected your questions, we have put them into categories, we have removed the redundancy and these cannot be personal questions because it is unethical, so we are going to try to keep them on topic and not about a person and they will read them to me, right stack, wrong.

Oh, okay, wrong stack, like Dr. bar said.