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Gluten Free Recipe:

Crustless Quiche in a Cup
Prep Time: 10 mins  Cooking Time: 30 to 40 minutes
4 eggs
4 egg whites
1/2 cup lowfat milk
1/2 cup shredded part skim mozzarella cheese
1/2 cup shredded cheddar cheese
2 cups fresh broccoli florets
fresh pepper & sea salt

Preheat oven to 350 degrees. Blanch the broccoli in boiling water, dry and chop up into small pieces and set aside. Also set aside 2 to 3 tablespoons of cheddar cheese for sprinkling on top of quiche. Meanwhile, in a large bowl combine eggs and whites and lightly whisk together. Add milk and continue to whisk together. Stir in all remaining cheese and broccoli and finish off with salt and pepper to taste. Spray cups or ramekins with cooking spray and place on a baking sheet. Divide egg mixture evenly among cups, sprinkle with cheddar cheese and bake for 30 to 40 minutes or until beginning to brown.  An 8oz ramekin should yield 4 quiches.  Note: Coffee cups are generally a bit bigger/deeper than 8oz.  If you are using mugs and you want to get the quiches to pop out like the picture (above) it’s best to divide the recipe among 3 cups instead of 4.
Empowerment Scholarship Accounts (ESA)
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What can ESA funds be spent on?
According to the Arizona Department of Education, "Additional eligible expenses for children with special needs include:
Educational therapies or services from a licensed or accredited practitioner or provider"
Please contact us or 
for details on using your ESA.
Thursday, April 19, 2018
 6:30 PM - 8:30 PM 
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Friday, May 18
Monday, June 4
Friday, June 15
Monday, June 18
Friday, June 29
Did You Know?
SIRRI offers these services
for both children & adults:
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Childhood Aggression Linked to Deficits in Executive Function
March 2018
You may have heard it from teachers and counselors, "Your child has ADHD and weak Executive Function."  
Executive Function is a term used to explain brain processes needed to plan, prioritize, and organize. Executive Function helps us avoid procrastination, make good decisions by avoiding impulsive behaviors, and remain on task. Research has now linked childhood aggression to deficits in Executive Function.
"The study, published in open-access journal Frontiers in Behavioral Neuroscience, shows that primary school children with lower Executive Function were more likely to show physical, relational and reactive aggression in later years, but not proactive aggression. The increased aggression -- which was observed in both boys and girls -- may be partly due to an increased tendency for anger in these children. The findings suggest that helping children to increase their Executive Function could reduce their aggression."
Our focus at Play Attention is to help children and adults with attention difficulties strengthen Executive Function and Self-Regulation.  We know strong Executive Function is critical to school and workplace success.
No one is born with strong Executive Function.  However, everyone is born with the potential to develop strong Executive Function.  Play Attention can help.
We know strong Executive Function is built on the foundation of cognitive skills. Play Attention's feedback technology teaches these specific cognitive skills such as staying on task, attention training, memory training, etc.
Play Attention also includes a full behavior shaping program that teaches children and adults how to control disruptive or impulsive behaviors.  The constant and immediate feedback provided by our BodyWave technology further develops one's ability to self-monitor and self-regulate. 
The results of the study cited above suggests that, "training programs that help children to increase their Executive Function, and manage their anger, could reduce their aggression."
Attend an upcoming SIRRI Information Session or schedule an appointment and learn how we can customize a program that improves Executive Function and Self-Regulation. 

Consistent use of ADHD medication may stunt growth by 2 inches, large study finds

By Dr. David Rabiner
Child Clin­i­cal Psy­chol­o­gist
Direc­tor of Under­grad­u­ate Stud­ies
Depart­ment of Psy­chol­o­gy and Neu­ro­science
Duke Uni­ver­si­ty
 March 16, 2018
The Mul­ti­modal Treat­ment Study of ADHD (MTA Study) is the largest ADHD treat­ment study ever con­duct­ed — near­ly 600 7–9-year-old chil­dren with ADHD were ran­dom­ly assigned to one of four inter­ven­tions:
1) Care­ful­ly mon­i­tored med­ica­tion treat­ment;
2) Inten­sive behav­ior ther­a­py;
3) Med­ica­tion Treat­ment com­bined with Behav­ior Ther­a­py; or
4) Com­mu­ni­ty Care (par­ents obtained what­ev­er treat­ment they desired).
After 14 months, results indi­cat­ed that chil­dren receiv­ing care­ful­ly mon­i­tored med­ica­tion treat­ment or med­ica­tion treat­ment plus inten­sive behav­ior ther­a­py had low­er lev­els of ADHD symp­toms and some­what bet­ter over­all adjust­ment com­pared to those receiv­ing inten­sive behav­ioral treat­ment alone or reg­u­lar com­mu­ni­ty care.
Ten months after study treat­ed had end­ed, chil­dren who had received inten­sive med­ica­tion treat­ment — either alone or in com­bi­na­tion with behav­ior ther­a­py — were still doing bet­ter than those who received inten­sive behav­ior ther­a­py only or com­mu­ni­ty care.
The mag­ni­tude of the rel­a­tive ben­e­fits, how­ev­er, had been reduced by about 50% com­pared tot the ini­tial out­come assess­ment. And, when par­tic­i­pants were assessed again a year lat­er, no group dif­fer­ences based on ini­tial treat­ment assign­ments were found; the same was true when par­tic­i­pants were eval­u­at­ed again sev­er­al years lat­er dur­ing ado­les­cence. Thus, the ini­tial ben­e­fits asso­ci­at­ed with care­ful­ly mon­i­tored med­ica­tion treat­ment had evap­o­rat­ed; this is not sur­pris­ing giv­en that many par­tic­i­pants had stopped tak­ing med­ica­tion and the care with which this treat­ment was pro­vid­ed dur­ing the treat­ment phase of the study was no longer avail­able.
The researchers con­tin­ued to fol­low the sam­ple annu­al­ly through age 18 and then on a reduced sched­ule to age 25. Dur­ing the annu­al assess­ments, infor­ma­tion on treat­ments received in the pri­or year was obtained; par­tic­i­pants were con­sid­ered to have received med­ica­tion treat­ment if they had tak­en the equiv­a­lent of at least 10 mg of methylphenidate on at least half the days dur­ing the year. Based on this annu­al med­ica­tion use data through age 18, 3 med­ica­tion use groups were formed:
a) Con­sis­tent, i.e,. those who had met the min­i­mum thresh­old dur­ing each year;
b) Incon­sis­tent, i.e., those meet­ing the min­i­mum thresh­old in some but not all years; and
c) Neg­li­gi­ble, i.e., below the min­i­mum thresh­old in all years.

The Latest Results

At the most recent fol­low-up assess­ment when par­tic­i­pants were 25, self- and par­ent-report­ed ADHD symp­toms were obtained. In addi­tion, the researchers mea­sured par­tic­i­pants’ height. This data was also col­lect­ed on a group of com­pa­ra­bly aged young adults from the same com­mu­ni­ties who had not been diag­nosed with ADHD in child­hood, i.e., com­par­i­son sub­jects.
Con­sis­ten­cy of med­ica­tion useOnly 14.3% of par­tic­i­pants used med­ica­tion con­sis­tent­ly through age 18; remem­ber, this does not reflect opti­mal med­ica­tion treat­ment but only that a min­i­mum thresh­old was met each year. Twen­ty-three per­cent had not met this thresh­old in any year and the remain­ing 69% were in the Incon­sis­tent use group, with the thresh­old met for some years but not oth­ers.
Per­sis­tence of symp­tomsRel­a­tive to com­par­i­son sub­jects, par­tic­i­pants with ADHD main­tained sub­stan­tial­ly high­er ADHD symp­toms over time based on the aver­age of their self-report and their par­ents’ report. The mag­ni­tude of this dif­fer­ence was large and indi­cates sub­stan­tial per­sis­tence of ADHD symp­toms into young adult­hood. Symp­toms report­ed by par­ents were sig­nif­i­cant­ly high­er than symp­toms report­ed by par­tic­i­pants them­selves.
Are ADHD symp­toms in young adult­hood relat­ed to pat­terns of med­ica­tion use through ado­les­cence? The clear answer to this ques­tion was NO. Regard­less of whether par­tic­i­pants were Con­sis­tent, Incon­sis­tent, or Neg­li­gi­ble users of ADHD med­ica­tion through ado­les­cence, their self- and par­ent-report­ed ADHD symp­toms were quite sim­i­lar. There was thus no indi­ca­tion that con­sis­tent med­ica­tion treat­ment over a num­ber of years had any per­sis­tent impact.
Is there an asso­ci­a­tion between per­sis­tent med­ica­tion use and adult height?This asso­ci­a­tion was found. Stu­dents in the Con­sis­tent and Incon­sis­tent med­ica­tion treat­ment groups had aver­age heights — com­bined across these groups — that were about an inch short­er than those in the Neg­li­gi­ble treat­ment group. And, par­tic­i­pants in the Con­sis­tent Group were near­ly an inch short­er on aver­age than those in the Incon­sis­tent group, i.e., near­ly 2 inch­es short­er than those in the Neg­li­gi­ble group.


Three broad con­clu­sions can be drawn from this study.
First, there was sub­stan­tial per­sis­tence of ADHD symp­toms into adult­hood. Although not mean youth with ADHD con­tin­ue to strug­gle with ADHD as adults, this is not a con­di­tion that most chil­dren sim­ply out­grow. Rather, it is like­ly to be a chron­ic con­di­tion that must be man­aged effec­tive­ly over time. Keep­ing effec­tive treat­ment in place over many years, while extreme­ly chal­leng­ing, may often be nec­es­sary.
Sec­ond, although the ben­e­fits of med­ica­tion treat­ment on ADHD symp­toms dis­si­pate, the impact on adult stature per­sists. Con­sis­tent med­ica­tion treat­ment through ado­les­cence was not linked to reduced symp­toms in young adult­hood; unfor­tu­nate­ly, how­ev­er, it was asso­ci­at­ed with reduced adult height . The impact on height was not triv­ial, with aver­age dif­fer­ences between Con­sis­tent and Neg­li­gi­ble med­ica­tion treat­ment groups of rough­ly 2 inch­es. One impli­ca­tion of this find­ing is that reduc­ing med­ica­tion dose, which can be done when med­ica­tion is com­bined with behav­ior ther­a­py, could be an effec­tive way to mit­i­gate adverse height out­comes.
While these are inter­est­ing and impor­tant find­ings, cau­tion is required in draw­ing cer­tain con­clu­sions. It would be erro­neous to con­clude that med­ica­tion treat­ment has no long-term ben­e­fits as only core ADHD symp­toms were exam­ined. It remains pos­si­ble that ben­e­fits on oth­er impor­tant out­comes not exam­ined here, e.g., edu­ca­tion­al attain­ment, work his­to­ry, etc., were asso­ci­at­ed with con­sis­tent med­ica­tion treat­ment. It is also true that med­ica­tion treat­ment after the 14-month treat­ment por­tion of the study end­ed was no longer man­aged and mon­i­tored as it had been.
These data also pro­vide don’t address whether adults who con­tin­ued to take med­ica­tion were ben­e­fit­ing from it. The find­ings report­ed here high­light that endur­ing med­ica­tion ben­e­fits should not be expect­ed; instead, what­ev­er ben­e­fits this treat­ment pro­vides while in place will like­ly dis­si­pate when it stops.
Final­ly, while it is tempt­ing to con­clude that stim­u­lant med­ica­tion treat­ment was the cause of reduced adult stature, the design of the study does not ful­ly allow sup­port this con­clu­sion. It is pos­si­ble that some oth­er fac­tor that con­tributed to some par­tic­i­pants tak­ing med­ica­tion more con­sis­tent­ly, e.g., more severe symp­toms, also explains the reduced height attain­ment in this group.

Take-Home Message

These lim­i­ta­tions and uncer­tain­ties not with­stand­ing, sev­er­al ‘take home’ mes­sages are impor­tant.
First, rel­a­tive­ly few youth with ADHD use med­ica­tion con­sis­tent­ly over their devel­op­ment, even though it is the treat­ment that cur­rent­ly has the strongest empir­i­cal sup­port for reduc­ing symp­toms.
Sec­ond, many with ADHD will con­tin­ue to strug­gle with ADHD symp­toms into adult­hood, even though some show sig­nif­i­cant reduc­tions in core symp­toms over time.
Third, although med­ica­tion helps con­trol symp­toms in the short-term, it is not a cure. Even long-term treat­ment pro­vid­ed in com­mu­ni­ty set­tings does not seem to yield per­sis­tent ben­e­fits on core symp­toms.
Fourth, we don’t know whether opti­mal med­ica­tion treat­ment main­tained over many years would have a greater impact. Unfor­tu­nate­ly, the study required to answer this ques­tion will prob­a­bly nev­er be done.
Final­ly, par­ents and clin­i­cians need to bal­ance the need for per­sis­tent treat­ment in some chil­dren with the like­ly con­se­quences of reduced adult height. Whether or not this is an impor­tant con­cern may depend on the height a child would have oth­er­wise attained.
Because height reduc­tion would like­ly be linked to cumu­la­tive expo­sure to stim­u­lant med­ica­tion over time, work­ing to find the low­est effec­tive dose is a good prac­tice. In many cas­es, this can be achieved by com­bin­ing med­ica­tion treat­ment with oth­er behav­ior ther­a­py and/or oth­er approach­es.
SIRRI Arizona • 4515 S. McClintock Drive, Suite 208 • Tempe, AZ 85282
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