ADD and ADHD Attention Deficit Hyperactivity Disorders

ADD and ADHD Attention Deficit Hyperactivity Disorders TO U C H I N G L I V E S , M A K I N G A D I F F E R E N C E . . . E V E RY DAY . Contents E...
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ADD and ADHD Attention Deficit Hyperactivity Disorders

TO U C H I N G L I V E S , M A K I N G A D I F F E R E N C E . . . E V E RY DAY .

Contents

Everyday Angels

Shades of Gray Matter: Understanding ADD & ADHD..............................3 Digital Mammography, the Latest in Breast Health.....5 The Legacy Circle.........................................................6 I’m Proud to be an Evan Baby......................................7 Welcome New Physicians.............................................7 ADD: Being Different vs. Being “Better”......................8 Part of the Family.......................................................10 Photo Gallery............. ................................................11 Health & Wellness Programs..............Center Pull-Out

CREDITS: The Evangelical Community Hospital News is published by the Public Relations Department of Evangelical Community Hospital. DIRECT INQUIRIES TO: Angela Brouse Public Relations Manager One Hospital Drive Lewisburg, PA 17837 www.evanhospital.com [email protected] EDITOR: Angela Brouse

“Feeling overwhelmed is a perfectly normal response to a breast cancer diagnosis. We make it a priority to utilize all of our team members here at the Thyra M. Humphreys Center for Breast Health to deliver exceptional patient care. We treat our patients as if they were our own mothers, sisters, daughters and friends.” Beth Jordan, Nurse Practitioner Thyra M. Humphreys Center for Breast Health

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CONTRIBUTING WRITERS: Mellissa Gayer Elizabeth Hendricks Kelly Herbster Nichole Hockenbrock Tami Radecke ART DIRECTION/DESIGN: Sheri Reber Additional copies of Evangelical News are available at the Hospital, Susquehanna Valley Mall, and our satellite offices.

SHADES OF GRAY MATTER: Understanding ADD & ADHD “Diagnosis for ADD and ADHD is not as easy as some parents and teachers may believe.” - Richard E. Dowell, PhD Neuropsychologist Evangelical Neurosciences

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ost of what you think you know about Attention Deficit Disorder (ADD) is wrong. There. Did that get your attention? Most Americans have an understanding of ADD and its sister disorder, Attention Deficit Hyperactivity Disorder (ADHD), their symptoms and particular treatments. A child has trouble sitting still for any length of time, finds it difficult to focus in school and may have behavior problems due to a lack of impulse control. It sounds like a clear case of ADD, doesn’t it? However, as with most psychological conditions, the happenings in the human brain are simply not black and white. There are innumerable shades of gray in that gray matter. Richard E. Dowell, PhD, a neuropsychologist with Evangelical Neurosciences, has spent the better part of his 18-year career studying children and the symptoms of attention disorders.

And those symptoms can have many causes, both neurological and psychological, and many treatment options resulting from those causes. The challenge for Dr. Dowell is to look inside the child’s brain and deduce which shades of gray are functioning, which are not, and how to get them to work together harmoniously.

GRAY SKIES, STORMY WEATHER When explaining attention disorders and their diagnoses, Dr. Dowell uses the analogy of a weather forecaster. “A weatherman will talk about three things when delivering the news: the current conditions, the severity of those conditions and their causes,” he explains. “It is the same with the human brain. Those three factors tell a lot about the functioning of the brain. When you pinpoint those three fac-

tors—the condition, the severity and the cause—you can begin to treat the symptoms.” Where do you begin to understand the “weather” inside the mind of a child? Is it storming aggressively all the time and doesn’t stop? Or is it only mildly foggy, with a chance of a violent outburst? Perhaps it is mostly sunny, but becomes cloudy when the child tries to recall what he or she learned in school that day. What is the process to understand these patterns? “Diagnosis for ADD and ADHD is not as easy as some parents and teachers may believe,” Dr. Dowell notes. “The first step to understanding the child and his or her brain function is to perform a screening, where we hear the child’s story. What are the symptoms? What is the child’s environment like? In what specific areas is the child having trouble? In what areas is the child doing well? What are his or her Evangelical News Summer 2006 3

strengths? In most cases, the child is in the average range developmentally when compared with others in his or her peer group but may be lacking in one particular area.” Pinpointing that weakness is essential in diagnosing an attention disorder.

HARDWARE VS. SOFTWARE As a neuropsychologist, Dr. Dowell has a unique perspective on the subject of attention disorders. He assesses the neurological side of the coin, or the “hardware” of a child’s brain, as well as the psychological side, the “software” that is acquired through the child’s environment and learned behaviors. “Both neurological and psychological factors play into a person’s success in life,” he explains. “To truly understand a person’s strengths and weaknesses, and to develop a plan that will allow them to interact well together, you must look at both parts.” The “hardware” of the human brain is arranged so that certain sections of the organ govern particular functions. To be specific, these functions are the ability to focus, to learn, to understand verbal information and the visual perception of a person’s surroundings. The final function acts as the “executive” for the brain, acting as a coach for the rest of the brain’s functions, helping to organize and plan, as well as adapt to changing circumstances. The upper brainstem region governs a person’s ability to focus and regulates stimulation. “This section of the brain has both a gas pedal and a brake, which control inhibitions. Children who have a poor ‘brake’ function will have a shorter attention span, or be more apt to daydream. They’ll also have difficulties with levels of arousal, either have trouble falling asleep or have periods of interrupted sleep,” he says. This set of weaknesses is common among children diagnosed with classic ADD or ADHD symptoms.

Richard E. Dowell, PhD, Neuropsychologist, Evangelical Neurosciences

The limbic system also has a gas pedal and a brake, but this set of regulators is responsible for basic drives and instincts, like territoriality and aggression. The “fight or flight” response originates in the limbic system as well, and is associated with acting out in anger, or depression, which is anger turned inward. This system also acts as a VCR of sorts, primarily recording the things that happen throughout the course of the day, and helping the person to learn new information. “Children with ADD have little trouble with the recording function of the brain’s VCR; their VCRs simply don’t record the same information as other stu-

dents,” Dr. Dowell explains. “Instead of the multiplication tables the teacher went over that afternoon, the child remembers that the person next to him dropped his pencil during class.” The right hemisphere of the brain oversees visual perception, making sense of what a person sees and deciphering non-verbal clues when talking with others. The left hemisphere of the brain works to understand verbal cues. In children with attention disorders, these cues can be masked since other parts of their brains are not allowing them to give their full attention. Lastly, the frontal lobe of the brain acts as the executive or coach of the Shades of Gray Matter: continued on page 9

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often means a woman will not need to return to get a second screening. The physician gets a clearer picture, contributing to a more accurate screening and diagnosis. Every mammogram is then screened a second time using Evangelical’s advanced computer-aided detection system. To schedule your mammogram, call the Thyra M. Humphrey’s Center for Breast Health at 522-4200.

This certificate entitles you to one FREE* OSTEOPOROSIS SCREENING

Digital Mammography The Latest in Breast Health

A value worth up to $25 Evangelical Medical Services Building Route 522 Selinsgrove Monday—Friday: 8 am—4:30 pm

570-372-6130 *Registration is required. Call to schedule. Expires December 31, 2006

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urning 40 can bring about many new challenges and adventures in a woman’s life. Many women feel more sure of themselves and the direction in which they are headed. Others are ready to set out on new adventures. Yet one of the most important things a woman can do for herself at age 40 (or sooner depending on family history) is to schedule her first of many annual mammograms. Okay, so a mammogram appointment may not be the thing that women look forward to at age 40. However, it is one of the most important things that women can do to prevent or detect cancer in its earliest stage. Evangelical knows the importance of mammography in a woman’s life. That’s why we are now offering digital mammography at the Thrya M. Humphreys Center for Breast Health. Digital mammography is the most advanced technology in breast cancer detection and diagnosis. Why get a mammogram? According to the National Cancer Institute, breast cancer mortality is second only to that of lung cancer. For women ages 40-55, it is the leading cause of death. Because of its role in early tumor detection, mammography has played a substan-

tial role in reducing this mortality rate by 20 percent in the last decade. The digital capabilities at Evangelical have now advanced that screening process to help improve detection at its earliest stages. Digital mammography offers several benefits for patients. It is performed with less radiation exposure to the breast and the images are a better quality than traditional analog mammography. “Better image quality translates into better patient care,” notes John Turner, MD, Medical Director of the Thyra M. Humphrey’s Center for Breast Health. “Because digital mammography is a much more sensitive exam, changes in the breast that are suspicious for cancer, such as micro-calcifications, can be seen sooner. Now breast cancer can be detected at an earlier stage and there is a greater chance for cure.” Further, the image quality and resolution with digital mammography is far superior to that of film mammography. Digital mammography allows the radiologist to adjust and enhance the images, which improves accuracy and

Criteria for FREE Heel Ultrasound Bone Density Test • Have not had a DXA scan in the past two years • Have not had a heel bone density test in the last year • Over the age of 65 and postmenopausal; or • Pre-menopausal with one of the high-risk factors High-Risk Criteria • Weight less than 127 pounds • Family history of osteoporosis • Personal history of low trauma fracture • Current cigarette smoker • Taking any of the following medications - Oral steroids - Cancer treatment (including radiation and chemotherapy) - Epileptic medications - Immunosuppressive medications • Being diagnosed with one of the following conditions that cause bone loss: - Hyperthyroidism - Hyperparathyroidism - Cancer - Malabsorption Conditions - Kidney Disease - Cushing’s Disease - Multiple Sclerosis - Rheumatoid Arthritis - Endometriosis - Chronic Lung Disease

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n 1997, the Hospital’s Board of Directors established “The Legacy Circle” as a recognition society for our friends who have let us know that they have included Evangelical in their estate plans. Members of the Legacy Circle are listed on a plaque in the Robert L. Rooke Pavilion and are invited to the Legacy Circle luncheon in June each year. To date, the Legacy Circle consists of 60 members who have chosen to leave a legacy at the Hospital. Many people think that in order to add a charity as a beneficiary in their will they must re-write the entire document. However, this is not the case at all. To add a charity such as

Evangelical Community Hospital to your existing will, all you need to do is contact your attorney and ask about adding a codicil to your will. A codicil is simply a few extra sentences stating that you have named Evangelical as an additional beneficiary of your estate. You can specify a dollar amount or a percentage of your estate. Last year, the Hospital was the recipient of nearly $450,000 from those who passed away and chose to leave all or a portion of their estate to benefit Evangelical. Gifts of cash, stock, real estate and life insurance are just a few examples of the types of gifts Evangelical has received in the past.

❏ ❏ Name On June 1, 2006, Evangelical Community Hospital hosted an annual luncheon for more than 25 of its Legacy Circle members. Guests were treated to a special lunch at the Hospital, live entertainment and a special presentation given by guest speaker, Hospice Manager Rebecca Davis.

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Address

Phone

By including Evangelical in your will, you can make an investment in the Hospital’s future and help to ensure that it remains a financially sound community resource for many generations to come. If you are interested in learning more about the Legacy Circle, please call Mellissa Gayer at 522-2685 or visit our website at www.evanhospital.com. You can also complete the attached form and mail it to: Evangelical Community Hospital Ms. Mellissa Gayer One Hospital Drive Lewisburg, PA 17837

Yes, I have included Evangelical in my will and would like to join the Legacy Circle. Yes, I would like more information about including Evangelical in my will.

I’m Proud to be an

Evan Baby! We asked, and you answered. Boy did you ever answer! We wanted to know how many Evan Babies were out there and we received an overwhelming response. As a matter of fact, 2,130 people contacted us to share their pride about being born at Evangelical Community Hospital. “We had responses from as far away as Iraq, Thailand, Holland and Japan to many right here in Lewisburg and the Central Susquehanna Valley. There are Evan Babies all over the world,” says Tami Radecke, Vice-President of Community Relations. “We heard from parents of newborn babies to people who were born 60, 70, and even

80 years ago. The broad spectrum of participants was just amazing.”

The results of the Evan Baby Contest are in!

Stay tuned for more features on these special Evan Babies. To view a complete list of all of our Evan Babies, visit our website at

www.evanhospital.com.

Oldest Living Baby June Evelyn Forbes, born on July 13, 1926. Baby Living the Farthest Distance Tamara Graybill, living 8,313 miles away in Thailand. Most Family Members Born at Evangelical The Russell Family with 37 members. Most Unique Baby Naomi Peay, the first female born in her family in 100 years. Most Famous Baby Jason Bohn, originally of Mifflinburg – PGA golfer.

Welcome

New Physicians

Nicholas C. Fasano, MD

Lisa K. Strawser, MD

specializing in diagnostic radiology with Radiology Associates of Lewisburg.

specializing in diagnostic radiology with Radiology Associates of Lewisburg.

Maria Fullana-Jornet, MD specializing in obstetrics and gynecology at OB/GYN Associates of Lewisburg.

Paul Sutton, MD specializing in allergy and immunology at Allergy Partners of Lewisburg.

John J. Kryston, MD specializing in anatomic and clinical pathology with the Evangelical Medical Services Foundation Pathology Group.

Evangelical News Summer 2006 7

ADD: BEING DIFFERENT

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said, “I could put you on a treatment plan, but I don’t think you want to be on one anymore, and I don’t want to do that either. At this point, you just need to find a place where you fit in the world. And, in our early twenties, don’t we all?” Having graduated from Susquehanna University this past May, Miller acknowledges the hard work expended to complete this huge task. But surprisingly, graduating from college is not what she would bill as her biggest triumph. “I’ve never given up on myself,” she says. “College was a long haul, and overwhelmingly difficult sometimes. But I never gave up. That’s my greatest accomplishment.” Her plans for the future are similar to many recent college graduates’ plans. “I’m not sure yet,” she says. “I’m still looking for my path. School is not my favorite thing, but I don’t think I could ever stop feeding my mind and my soul. I guess my plan in life is to continue to do just that. Find a job, community and people that I can be myself around.”

her to focus, and there was a marked improvement in her grades, there were also downsides. “I just didn’t feel like myself. The medications were definitely working, but at a price,” she says. “I ended up feeling very toned down, like a flatline. ” Her disorder, and its treatment, also had an effect on her social skills. “The medications zapped my energy. I didn’t feel like interacting with people.” It can be difficult to make friends when “feeling like a drone,” as Miller claims. “I was ‘better,’ but I wasn’t myself. And eventually, I had to decide which was more important to me.” During her college years, Miller’s physician weaned her off of the Adderall. However, she was permitted to take it on occasion. “If I felt I was going to have a particularly hard day, I could still take it for that day and feel its benefits. It was different from other medications that take months to build up in your system. That was very helpful to me through exam times.”

“I love the fact that I think differently, and can analyze things in a different way than most people. It’s part of what makes me ‘Me.’” Miller met with Richard E. Dowell, PhD at Evangelical Neurosciences in November 2005 and left his office feeling relieved and renewed. “I’m not sure what I expected of that appointment, since I had been in treatment for so long,” she remembers. “He evaluated me and the place that I was in during that time of my life, and came to the same conclusion that I did.” He

Reprinted with permission of Chappell Studio, Inc.

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or Lauren Miller of Selinsgrove, being able to focus on her schoolwork was a necessity if she wanted to improve her grades. Having been diagnosed with ADHD when she was eight years old, Miller has years of experience dealing with this disorder, including coming to terms with the word “disorder.” “Giving a name to what I was feeling was important, but when the name was a ‘deficit disorder,’ that was pretty difficult to understand,” she says. “In school, I felt that I wasn’t being challenged enough, and found it hard to concentrate on stuff that I felt was pretty easy. It was hard to deal with the fact that there was something ‘wrong’ with me, something that needed to be fixed in me.” She continues: “Teachers would think that I was stupid because I wouldn’t hand in homework and had poor study habits. I just didn’t think in the same way, using the same patterns as the other kids, or the teachers for that matter.” Math was a particularly difficult subject for her to master. “In math, there is a right answer and plenty of wrong answers. I usually came up with the right answer, but because my mind didn’t operate in the way that it was expected to, I had a hard time following the steps laid out by the teacher to get to the right answer. I got there eventually, but I just took a different set of directions. Sometimes it was the longer route, and sometimes the shorter. But I got there.” At age eight, her neurologist prescribed Ritalin, which she continued to take through high school. In her junior year, her treatment changed to daily doses of Adderall, a similar drug. While the medications did help

VS. BEING “BETTER”

President of Susquehanna University, L. Jay Lemons, PhD, presents Lauren Miller her diploma.

Shades of Gray Matter: continued from page 4

rest of the brain. One important function of the frontal lobe is the management of social rules, those that inhibit us from acting out our limbic systemdriven instincts of “fight or flight.”

W HAT IS “NORMAL” ANYWAY? For Dr. Dowell, understanding those complex systems and how they interact is not the hard part. The challenge is determining what hardware is functioning properly, and which is lagging behind. He also looks to see if the software, the outside forces that have a great influence over a person’s behavior, is a contributor to the problem. To figure out those interactions, testing must be done. After the screening process, Dr. Dowell begins a series of tests. The one-on-one testing has the child playing a variety of games. Word and number puzzles, hand-eye coordination games, memory tests and other games isolate certain functions of the brain, allowing Dr. Dowell to pinpoint areas of struggle for the child. This testing is intense, but is typically spread out over the course of a few days. In addition to the child’s tests, this phase also includes a series of questions for the parents, to better understand the home and school environment, the history of the child, and his or her difficulties. All of these tests, both the child’s and the parents’ portions, point back to the severity and cause of the child’s “weather conditions.” Through this data, Dr. Dowell is able to establish how much the child deviates from the bell curve, that is, the average of the abilities of his or her peers. In other words, the bell curve is what would be described as “normal.” “In many cases, the student is right on track with others in his or her class in most areas of ability and skill,” he explains. “But if a child is lacking in even one area of the brain (for example, the ability to focus), it will affect his

performance in school and have repercussions in most aspects of his life, such as social and emotional interactions,” he concludes. Figuring out the severity and cause of the child’s difficulties allows Dr. Dowell to establish a treatment plan. During a feedback session with the parents, he discusses all of his findings, often drawing easily understood diagrams and charts to illustrate the complexities of the brain. “Typically, I develop a treatment plan, but the treatment of the child is a group effort,” he says. “I like to include many people in the child’s treatment: family, friends, school members, people he interacts with at church. It is important that people around the child have an understanding of the plan.” Dr. Dowell also gives the parents homework of their own. “I encourage parents to educate themselves, and in turn educate others. I could easily recommend a treatment plan and say ‘This is all you need to do. Here’s what’s going to work for you.’ But it rarely works that way,” he says. “That’s just giving someone a fish and feeding him or her for a short period of time. But by educating themselves, they are learning to fish and can continue to eat for a lifetime.”

CONCLUSION There are as many types of attention disorders as there are people diagnosed with them. And there are as many types of successful treatment choices as there are people who opt to use them. So all of those shades of gray, the way the black and white world swirls together in the mind of a child with ADD or ADHD, do matter. They are the key to understanding the round pegs in this square world, and how we can better appreciate how they fit in it.

Symptoms typically exhibited in ADD and ADHD students:

INATTENTION • Unable to consistently focus, remember or organize • Experiences difficulty completing tasks that are boring, repetitive or challenging • Easily distracted by irrelevant sights and sounds • Makes careless mistakes • Rarely follows instructions • Frequently loses or forgets things like toys, pencils, books, or things needed for a task

IMPULSIVITY • Has trouble making sound judgments or solving problems • Experiences difficulty developing and maintaining personal relationships • Unable to keep a job over a long period of time, and does not spend money wisely

HYPERACTIVITY • Skips from one uncompleted activity to another • Squirms, fidgets, climbs or runs when not appropriate • Blurts out answers before hearing the whole question • Struggles while waiting in line or taking turns Source: Learning Disorders Online: www.ldonline.com WebMD: www.webmd.com Evangelical News Summer 2006 9

Part of the Family Nancy Fisher & Robbie Ravert I

f you ever strolled through The Family Place, Evangelical’s obstetrics unit, you have probably stopped by the nursery to take a quick peek at the newborn babies. Have you ever wondered what goes on behind the scenes, amid the joy and drama of bringing a new child into the world? Sisters Nancy Fisher and Robbie Ravert are part of The Family Place team and could tell you all about it. Together they have given 67 years to Evangelical Community Hospital. Robbie got an early start in cultivating her skills in caring for others. As a

teenager, she often baby-sat her older sister’s children. “Baby-sitting Nancy’s kids helped me to learn how to be more organized and work with babies,” notes Robbie. Even before Robbie knew what career path she wanted to follow, Nancy saw potential in her to be a nurse. When Robbie was questioned about what she wanted to be when she grew up, Nancy would quickly respond, “a nurse. You want to be a nurse.” As it turns out, Nancy was right on point. As soon as Robbie was hired 34 years ago, Nancy did not hesitate to put her to work. In only one day, Nancy ori-

ented Robbie to the obstetrics department. When it was time for Nancy to take part in a delivery, she could often be heard calling to her sister, “Let’s go, Toots,” and Robbie would come running.

“It’s like a family at Evan,” says Nancy, “and the more you work here the more you appreciate it.” Although they are 14 years apart, their age gap has not kept these two siblings from being a big part of each other’s lives. When seen together, there is no mistaking the fact that they are good friends. “We’ve always worked well together” says Robbie, “like Mutt and Jeff,” two crazy comic strip characters popular in the 1940s. In the time that Nancy served at Evangelical she has been present for the birth of three generations of families who have consistently entrusted the care of their families to the Hospital. Nancy can recall a time when a father was so ecstatic about the birth of his new baby that he picked her up and swung her around joyfully yelling, “It’s a boy! It’s a boy!” The two women exhibit a strong compassion for people and great pride in being a part of The Family Place. Through their work together, both agree that they have developed a special connection: as sisters, co-workers and friends.

Siblings Robbie Ravert, RN (left), and Nancy Fisher, RN.

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Photo Gallery EARLY DETECTION SAVES LIVES The Second Annual Tell-A-Friend Mammathon, a joint effort between the Thyra M. Humphreys Center for Breast Health and the American Cancer Society, reached more than 450 women with the important message about mammography. During the event, 110 women scheduled their annual mammogram at the Center for Breast Health, and 116 made a commitment to schedule.

STARLIGHT BALL The 2006 Starlight Ball, a fundraising gala held by the Auxiliary to Evangelical Community Hospital, raised $16,000 to provide furnishings and equipment for the Hospital’s obstetrics unit, The Family Place. Pictured are committee members Kathleen Lybarger and Denise Haddon.

HOSPICE FLEA MARKET Evangelical Hospice recently held its annual flea market at Faith Lutheran Church in Lewisburg. The event raised nearly $3,000. Evangelical Hospice is a comprehensive program that assists patients and their families, friends and caregivers to come to terms with the emotions brought on by a terminal illness.

AUXILIARY ANNIVERSARY LUNCHEON The Auxiliary to Evangelical Community Hospital recently celebrated 75 years of service at its annual luncheon. At the event, each of the past presidents was honored and asked to share “Two-Minute Memories.” Here, event co-coordinator Niki Hockenbrock, Director of Community Health Education, presents past president June Hoyle with a commemorative pin.

BIKE HELMET EVENT AT MCDONALD’S Community Health Education at Evangelical recently held a bike helmet safety event at the Lewisburg McDonald’s, in conjunction with the Buffalo Valley AM and Lewisburg Kiwanis Clubs. The group fitted more than 130 children, ages 1-12, for bike helmets.

VOLUNTEER RECOGNITION DINNER Evangelical recently saluted its legion of volunteers at its annual Recognition Dinner at Bucknell University. Pictured are volunteers Jean Bingaman, Mary Brumbach, Jean Sanden and Jackie Portik.

Evangelical News Summer 2006 11

14th Annual Don Reed Memorial Motorcycle Tour

SUNDAY, NOVEMBER 19, 2006, SUSQUEHANNA VALLEY MALL

FROM

6-9

PM

Join us! Evening of Giving is a special night of shopping with special offers and discounts from more than 40 retailers. There are also many other perks for ticket holders including free gift-wrapping, childcare services, entertainment, door prizes and much more. All proceeds will benefit Evangelical Hospice. Stay tuned for ticket information.

SUNDAY, SEPTEMBER 10 The event benefits Evangelical Hospice, which provides care and support to terminally ill patients and their families. For more information or to register for this event, contact the Development Office at 522-2685 or visit our website at www.evanhospital.com.

Event Sponsor:

Co-Sponsors: Lewisburg Ford & Vreeland’s Harley-Davidson

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