11th Annual Pacer Symposium on Children L. Read Sulik, MD L. Read Sulik, MD L. Read Sulik, MD, FAAP, DFAACAP Chief Integration Officer, PrairieCare Executive Director, PrairieCare Institute Associate Professor, University of Minnesota Department of Psychiatry Child & Adolescent & Adult Psychiatrist August 9, 2016 1 11th Annual Pacer Symposium on Children L. Read Sulik, MD Today’s Goals • I am going to help you understand the incredible Spirited, Imaginative and Playful “gifts” common in individuals with ADHD • I am going to help you think about “Differences in Ability” rather than “Disorder” or “Disability” • I will teach you how the “Differences in Ability” lead to misinterpretations, unrealistic expectations and damaging responses • I will challenge you to think about how you can nurture the incredible nature of individuals with “Differences in Ability to Regulate” How Common is Attention Deficit Hyperactivity Disorder? • 7.2% children under 18 – meta‐analysis of 175 research studies globally in children and adolescents (Thomas et al. 2015). – The US Census Bureau: 1,795,734,009 people aged 5‐19 worldwide in 2013. – 129 million—number of children worldwide who have ADHD. • 3.4% adults – (Fayyad et al. 2007) What is Read’s Definition of Attention Deficit Hyperactivity Disorder? • An individual’s difference in ability to regulate: – Attention – Activity – Arousal – Behaviors – Thoughts – Emotions August 9, 2016 2 11th Annual Pacer Symposium on Children L. Read Sulik, MD Remember: “Difference in Ability” Common Problems as a result of the “difference in ability” Inattention Impulsivity Hyperactivity My Difference in Ability to Regulate My Activity causes others to see me as . . . • • • • • • • Too Fidgety Too Restless Too Loud In Constant motion Too easily excitable Talking too much Behaving Badly August 9, 2016 3 11th Annual Pacer Symposium on Children L. Read Sulik, MD My Difference in Ability to Regulate Attention causes others to experience me as . . . • • • • • • • Disorganized Avoiding tasks that require focus Losing things Distracted Forgetful Not very careful Transition poorly My Difference in Ability to Regulate My Self causes others to experience me as . . . • Thinking Weird • Too Impulsive – Blurt out – Interrupt – Overreact • Too Emotionally intense • Behaving Badly • “Bratty” My Differences in Ability causes others to experience me as . . . August 9, 2016 4 11th Annual Pacer Symposium on Children L. Read Sulik, MD Changes to our Thinking • Not an “inability” to pay attention • The “difference in ability” to regulate attention • Emotional immaturity due to developmental delay in the brain circuitry involved in inhibition and self-control • 3 to 5 year lag in emotional Shaw et al. 2007 maturity Remember: “Difference in Ability” August 9, 2016 5 L. Read Sulik, MD August 9, 2016 11th Annual Pacer Symposium on Children 6 11th Annual Pacer Symposium on Children L. Read Sulik, MD Prefrontal Cortex Regulates individual’s ability to stay focused, sustain attention, control impulses, and make decisions. Meaning and Purpose Emotional Dysregulation Behavior Problems Poorly Managed Differences in Ability Physical Dysregulation Relationship Problem Cognitive Dysregulation Performance and Functioning Problems August 9, 2016 7 11th Annual Pacer Symposium on Children L. Read Sulik, MD The 2007 National Survey of Children’s Health (NCSH) found that 33% of the children with ADHD had 1 coexisting condition, 16% had 2, and 18% had 3 or more (Larson 2011) Negative Response / Arousal Cycle Adult’s Arousal Negative Response Difference in Ability August 9, 2016 Child’s Arousal 8 11th Annual Pacer Symposium on Children L. Read Sulik, MD The 3 Gifts Spirited Imaginative August 9, 2016 9 11th Annual Pacer Symposium on Children L. Read Sulik, MD Playful Spirited • Full of energy, enthusiasm, and determination – Synonyms: lively, vivacious, vibrant, full of life, animated, sparkling, sprightly, energetic, enthusiastic, passionate, determined, resolute, purposeful, feisty, spunky, gutsy, peppy – Antonyms: timid, apathetic, lifeless, cold, dull, fearful, inactive, indifferent, lethargic, meek, shy, timid, tired, unenthusiastic, unexcited » spirited. (n.d.). Roget's 21st Century Thesaurus, Third Edition. Retrieved August 07, 2016 from Thesaurus.com website http://www.thesaurus.com/browse/spirited lively August 9, 2016 10 11th Annual Pacer Symposium on Children L. Read Sulik, MD vivacious vibrant full of life August 9, 2016 11 11th Annual Pacer Symposium on Children L. Read Sulik, MD animated sparkling sprightly August 9, 2016 12 11th Annual Pacer Symposium on Children L. Read Sulik, MD energetic enthusiastic passionat e August 9, 2016 13 11th Annual Pacer Symposium on Children L. Read Sulik, MD determined purposeful feisty August 9, 2016 14 11th Annual Pacer Symposium on Children L. Read Sulik, MD spunky gutsy peppy August 9, 2016 15 11th Annual Pacer Symposium on Children L. Read Sulik, MD Imaginative • Having or showing creativity or inventiveness – Synonyms: creative, visionary, inspired, inventive, resourceful, ingenious, original, innovative, unorthodox, unconventional, fanciful, whimsical, fantastic, Seussian, offbeat, zany – Antonyms: Unromantic, usual, dull, uncreative, unimaginative, uninventive, unresourceful » imaginative. (n.d.). Roget's 21st Century Thesaurus, Third Edition. Retrieved August 07, 2016 from Thesaurus.com website http://www.thesaurus.com/browse/imaginative Imaginasium August 9, 2016 16 11th Annual Pacer Symposium on Children L. Read Sulik, MD creative visionary inspired August 9, 2016 17 11th Annual Pacer Symposium on Children L. Read Sulik, MD inventive resourceful ingenious August 9, 2016 18 11th Annual Pacer Symposium on Children L. Read Sulik, MD original innovative unorthodox August 9, 2016 19 11th Annual Pacer Symposium on Children L. Read Sulik, MD unconventional fanciful whimsical August 9, 2016 20 11th Annual Pacer Symposium on Children L. Read Sulik, MD fantastic Seussian offbeat August 9, 2016 21 11th Annual Pacer Symposium on Children L. Read Sulik, MD zany Playful • Fond of games and amusement, lighthearted – Synonyms: cheerful, comical, frisky, jolly, lively, full of fun, frolicsome, sportive, high-spirited, light-hearted, exuberant, perky, mischievous, rascally, tricksy, lighthearted, jokey, humorous, good-natured, whimsical – Antonyms: apathetic, behaved, depressed, dispirited, grave, inactive, lazy, lethargic, lifeless, sad, serious, unhappy » playful. (n.d.). Roget's 21st Century Thesaurus, Third Edition. Retrieved August 07, 2016 from Thesaurus.com website http://www.thesaurus.com/browse/playful cheerful August 9, 2016 22 11th Annual Pacer Symposium on Children L. Read Sulik, MD comical frisky jolly August 9, 2016 23 11th Annual Pacer Symposium on Children L. Read Sulik, MD lively full of fun frolicsome August 9, 2016 24 11th Annual Pacer Symposium on Children L. Read Sulik, MD sportive high-spirited light-hearted August 9, 2016 25 11th Annual Pacer Symposium on Children L. Read Sulik, MD exuberant perky mischievous August 9, 2016 26 11th Annual Pacer Symposium on Children L. Read Sulik, MD rascally lighthearted humorous August 9, 2016 27 L. Read Sulik, MD 11th Annual Pacer Symposium on Children good-natured whimsical August 9, 2016 28 L. Read Sulik, MD 11th Annual Pacer Symposium on Children So how do you nurture the nature? August 9, 2016 29 11th Annual Pacer Symposium on Children L. Read Sulik, MD What Adults Must Do! • Develop a DEEP Understanding of the Differences in Abilities in ADHD • LOOK and SEE and APPRECIATE the Incredible Spirited, Imaginative and Playful Gifts! • Modify Expectations to fit the Differences in Abilities • Provide Unconditional Love and Admiration and Support of the Incredible Spirited, Imaginative and Playful Gifts! • Create Structure to Develop Positive Change in Ability to Regulate • Create Opportunities for Practice and for Success • Advocate, Advocate, Advocate • Model Our Own Process of Change – Insight, Intention, Structure, Practice, Monitor • Model Our Own Self‐Care and “Live the Work” – Breath, Think, Rest, Hydrate, Nourish, Move, Express, Behave, Connect, Build, Tend, Seek! Preparing for Change Insight August 9, 2016 30 11th Annual Pacer Symposium on Children L. Read Sulik, MD Intention Supportive Structure Practice August 9, 2016 31 11th Annual Pacer Symposium on Children L. Read Sulik, MD Monitor Spiritual World Seek Internal World Breathe Build Think Rest Tend The Work Connect Hydrate Behave Nourish Express External World Move Physical World © 2015 L. Read Sulik, MD August 9, 2016 32 11th Annual Pacer Symposium on Children L. Read Sulik, MD Individual Exercise What is your Current State (on a scale of 0 to 5) when 0 is the Ideal State in the center of the diagram and your score on each domain is how much change you must make to move from your Current State to your Ideal State Spiritual World Seek Breathe Build Internal World 5 Think 4 Rest Tend 3 The Work Connect 2 Hydrate 1 Behave External World Nourish Express Move 0 Physical World Ideal State The Work applies regardless of the condition . . . Ideal State Complicated ADHD So remember to ALWAYS . . . Look, See Admire, and Nurture August 9, 2016 33 L. Read Sulik, MD 11th Annual Pacer Symposium on Children the Incredible Spirited, Imaginative and Playful Nature! L. Read Sulik, MD, FAAP, DFAACAP Chief Integration Officer, PrairieCare Executive Director, PrairieCare Institute Associate Professor, University of Minnesota Department of Psychiatry Child & Adolescent & Adult Psychiatrist 1934 Hennepin Avenue South, Suite 300 | Minneapolis, MN 55403 952.826.8378 | Executive Assistant 952.903.1362 | Nurse 952.826.8429 | Office rsulik@prairie‐care.com August 9, 2016 34
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